Improved early outcome for end-stage dilated cardiomyopathy in children
Improved early outcome for end-stage dilated cardiomyopathy in children
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DOI：
10.1016/j.jtcvs.2003.07.029
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发表时间：
2003-12-01
影响因子：
6
通讯作者：
Elliott, M
中科院分区：
文献类型：
--
作者：
McMahon, AM;van Doorn, C;Elliott, M
目的：回顾治疗改变对儿童终末期扩张型心肌病早期结局的影响。方法：我们对自1992年以来接受住院治疗的所有末期扩张型心肌病连续儿童进行回顾性研究。在过去的3年里，进行了以下治疗改变：（1）更积极地使用机械心脏辅助； (2)高优先级移植列表； (3) ABO 血型不合婴儿移植。将 1992 年至 1999 年期间入院的 46 名患者（第一组）的结果与 2000 年至 2003 年 3 月期间入院的 53 名患者（第二组）进行比较。 结果：在第一组中，12 名患者（26%）接受了机械支持，其中 3 名患者康复，5 名患者接受移植（1 名死亡）。在第二组中，19 例（36%）患者接受了体外膜肺氧合，其中 5 例康复，12 例移植（全部存活）。机械辅助的使用与出血、终末器官衰竭和长期机械通气相关的高发病率相关。第二组中的 5 名患者接受了 ABO 不相容移植，全部存活。没有发生排斥反应或需要增加免疫抑制治疗。医院死亡率显着降低（I 组，37% vs II 组，11%；P
Objective: To review the impact of management changes on the early outcomes of end-stage dilated cardiomyopathy in children.Methods: We conducted a retrospective study of all consecutive children with end-stag e dilated cardiomyopathy who received hospital treatment since 1992. Over the past 3 years the following management changes were made: (1) more aggressive use of mechanical cardiac assistance; (2) high priority listing for transplantation; and (3) ABO incompatible transplants for infants. Outcomes for 46 patients admitted between 1992 and 1999 (group I) were compared with 53 patients between 2000 and March 2003 (group II).Results: In group I, 12 (26%) patients received mechanical support with recovery in 3 and transplantation in 5 (1 died). In group II, 19 (36%) patients received extracorporeal membrane oxygenation, with recovery in 5 and transplantation in 12 (all survived). The use of mechanical assistance was associated with high morbidity related to bleeding, end-organ failure, and long-term mechanical ventilation. Five patients in group II received ABO incompatible transplants and all survived. There have been no episodes of rejection or need for increased immunosuppressive therapy. Hospital mortality has been significantly reduced (group I, 37% vs group II, 11%; P