Outcomes of Berlin Heart EXCOR® pediatric ventricular assist device support in patients with restrictive and hypertrophic cardiomyopathy
Outcomes of Berlin Heart EXCOR® pediatric ventricular assist device support in patients with restrictive and hypertrophic cardiomyopathy
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Berlin Heart EXCOR® 儿科心室辅助装置支持限制性心肌病和肥厚性心肌病患者的结果
DOI：
10.1111/petr.13048
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发表时间：
2017
影响因子：
1.3
通讯作者：
J. Menteer
中科院分区：
文献类型：
--
作者：
J. Su;J. Menteer
舒张性心力衰竭患者接受儿科心脏辅助装置支持的结果尚未得到很好的描述。这项研究回顾了北美使用柏林心脏EXCOR®心脏辅助装置植入患有此类生理疾病的儿童的经验。回顾了柏林心脏临床数据库。这项研究包括有原发性舒张期功能障碍的患者。20例接受EXCOR®支持的儿童限制性心肌病(n=13)、肥厚型心肌病(n=3)、先天性心脏病伴限制性生理性心脏病(n=4)。在这些患者中，9人(45%)成功桥接至移植，1人(5%)脱离支持，10人(50%)在停止支持后死亡。在3岁以下的患者(n=13)中，38.5%的患者存活，而3岁或以上的患者(n=7)的存活率为71.4%(P=.35)。使用双心室辅助装置(BiVAD)的患者存活率为27.3%，而仅使用左心室辅助装置的患者存活率为77.8%(P=0.07)。主要死因包括中风、感染、酸中毒、多系统器官衰竭和出血。儿童舒张性心力衰竭患者是机械循环支持的高危人群。然而，有这种生理特征的患者中有一半已经成功地使用EXCOR®进行了植入术。年轻患者和接受BiVAD支持的患者死亡率上升的趋势值得考虑。
The outcomes of pediatric ventricular assist device support in patients with diastolic heart failure have not been well described. This study reviews the North American experience with Berlin Heart EXCOR® ventricular assist device implants in children with such physiology. The Berlin Heart clinical database was reviewed. Patients with primary diastolic dysfunction are included in this study. Twenty pediatric patients with restrictive cardiomyopathy (n = 13), hypertrophic cardiomyopathy (n = 3), or congenital heart disease with restrictive physiology (n = 4) who were supported with EXCOR® were identified. Of these, nine (45%) were successfully bridged to transplant, one (5%) weaned from support, and 10 (50%) died after support was withdrawn. Of patients under age 3 years (n = 13), 38.5% survived, whereas those aged 3 or older (n = 7) had 71.4% survival (P = .35). Biventricular assist device (BiVAD) patients experienced a 27.3% survival, vs 77.8% for patients with left ventricular assist device only (P = .07). Primary causes of death included stroke, infection, acidosis, multisystem organ failure, and bleeding. Pediatric patients with diastolic heart failure comprise a high‐risk population for mechanical circulatory support. However, half of patients with this physiology have been successfully supported to explant with EXCOR®. The trends toward higher mortality for younger patients and those receiving BiVAD support warrant consideration.