Postcaroiomy Heart or Heart/Lung Assist Experiences in Children

소아연령의 개심술후 시행한, 심장 혹은 심장-폐 순환보조장치의 임상적 고찰(Royal Children's Hospital, Australia의 경험)

  • Published : 1994.12.01

Abstract

From April 1989 to December 1993, total 39 patients who were unable to be weaned off CPB or expected fatal immediate postoperiatively, were treated with ventricular assist device [VAD] or extracorporeal membrane oxygenator[ECMO] at the Royal Children`s Hospital, Melbourne. Ages ranged from 3 day to 19.4 year old and body weights from 2.0Kg to 70Kg. Twenty-seven[69.2%] of 39 patients were weaned to be decannulated successfully and sixteen[41.0%] survived to hospital discharge and late survival rate was twelve[30.8%] of 39 patients. The total follow-up period was 4 to 56 months [32.92$\pm$20.77months] and most of the late survivals showed good myocardial recovery state. From the viewpoint of the assist modality, 29 patients were treated with VAD and among them, 23 were weaned from assist successfully, but among the 8 ECMO patients, only 3 could be weaned, and both modalities were performed to the 2 patients with one weaned. The total duration of assist was from 8 to 428 hours and there was a significant difference between hospital discharged group and hospital death group, which were 83.13$\pm$31.29 hours vs 147.52$\pm$112.03 hours[P=0.032]. Conclusively, at the critical postcardiotomy situation of the paediatrtic patients including various congenital complex disease and procedures, we can choose this VAD or ECMO treatment strategy as the reasonable life saving way except transplantation.

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References

  1. Ann. Thorac. Surg. v.42 Mechanical support of the failing heart Park,S.B.;Liebler,G.A.;Burkholder,J.A.(et al.)
  2. Ann. Thorac. Surg. v.55 Ventricular assist devices and total artificial heart: A combined registry experience Pae,W.E.
  3. J. Thorac. Cardiovasc. Surg. v.66 Prolonged extracorporeal oxygenation for cardiorespiratory failure after tetralogy c correction Soeter,J.R.;Mamiya,R.T.;Sprague,A.Y.;McNamara,J.J.
  4. J. Thorac. Cardiovasc. Surg. v.68 Prolonged extracorporeal cardiopulmonary support in man Bartlett,R.H.;Gazzaniga,A.B.;Gupta,K.B.(et al.)
  5. J. Thorac. Cardiovasc. Surg. v.104 Ventricular assist devices for postcardiotomy cardiogenic shock. A combined registry experience Pae,W.E.;Miller,C.A.;Matthews,Y.;Pierce,W.S.
  6. Cardiac Surgery:State of the Art Reviews v.7 Extracorporeal membrane oxygenation for pediatric cardiac support Spray,T.L.
  7. Crit. Care Med. v.21 Extracorporeal membrane oxygenation for cardiac rescue in children with severe myocardial dysfunction Dalton,H.J.;Siewers,R.D.;Fuhrman,B.P.(et al.)
  8. J. Thorac. Cardiovasc. Surg. v.102 Centrifugal pump left heart assist in pediatric cardiac operations. Indications, technique, and results Karl,T.R.;Sano,S.;Horton,S.;Mee,R.B.B.
  9. J. Thorac. Cardiovasc. Surg. v.93 Extracorporeal membrane oxygenation for postoperative cardiac support in children Kanter,K.R.;Pennington,D.G.;Weber,T.R.(et al.)
  10. Ann. Thorac. Surg. v.55 Circulatory support in infants and children Pennington,D.G.;Swartz,M.T.
  11. Circulation v.84 no.Suppl Ⅲ Extracorporeal life support for cardiac assist in Pediatric patients. Review of ELSO Registry Data Meliones,J.N.;Custer,J.R.;Snedecor,S.(et al.)
  12. Circulation v.86 no.Suppl Ⅱ Extracorporeal membrane oxygenator rescue in children during cardiac arrest after cardiac surgery Nido,P.J.;Dalton,H.J.;Thompson,A.E.;Siewers,R.D.
  13. J. Card. Surg. v.8 Long-term follow up after two coronary repair of anomalous left coronary artery from the pulmonary artery Dua,R.;Smith,J.A.;Wilkinson,J.L.(et al.)
  14. Circulation v.86 no.Suppl Ⅱ Extracorporeal membrane oxygenation in children after cardiac surgery Raithel,S.C.;Pennington,D.G.;Boegner,E.;Fiore,A.;Weber,T.R.
  15. J. Thorac. Cardiovasc. Surg. v.106 Transpostion of the great arteries with intact ventricular septum:arterial switch repair in patients 21 days of age or older Davis,A.M.;Wilkinson,J.L.;Karl,T.R.;Mee,R.BB.
  16. J. Thorac. Cardiovasc. Surg. v.86 Late functional and hemodynamic status of surviving patients following insertion of the left heart assist device Rose,D.M.;Colvin,S.B.;Culliford,A.T.(et al.)