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Long-term follow-up of pediatric cardiac patients requiring mechanical circulatory support
A E Ibrahim1, B W Duncan, E D Blume
1Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
Insights
Pediatric cardiac patients needing mechanical circulatory support show good long-term survival and heart function. However, extracorporeal membrane oxygenation (ECMO) use is linked to higher neurologic impairment rates compared to ventricular assist devices (VADs).
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Examining long-term outcomes for pediatric cardiac patients requiring mechanical circulatory support (MCS).
- Focus on patients supported by extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VADs).
Purpose of the Study:
- To compare the general health, cardiac status, and neurologic outcomes of pediatric cardiac patients treated with ECMO versus VADs.
- To identify factors associated with neurologic impairment in this patient population.
Main Methods:
- Retrospective study involving telephone interviews and questionnaires with parents and physicians.
- Data collected from in-hospital survivors of pediatric cardiac disease requiring MCS.
- Comparison of outcomes between ECMO and VAD support groups.
Main Results:
- High survival rates for both ECMO (96%) and VAD (91%) groups, with median follow-up of 42 months.
- Over 80% of survivors achieved New York Heart Association class I or II functional status.
- Significantly higher rates of moderate to severe neurologic impairment in ECMO patients (59%) compared to VAD patients (20%).
- Neurologic impairment linked to smaller patient size and circulatory arrest during surgery, not in-hospital complications.
Conclusions:
- Long-term survival and cardiac function are favorable for pediatric cardiac patients on MCS.
- ECMO-supported patients exhibit increased risk of neurologic impairment compared to VAD-supported patients.
- Younger patients with complex congenital heart disease are more prone to poor neurologic outcomes.
Background:
The present study examines the long-term outcome of pediatric patients with cardiac disease who required mechanical circulatory support with extracorporeal membrane oxygenation or ventricular assist devices.
Methods:
Telephone interviews and questionnaires were administered to parents and physicians of pediatric cardiac patients who were in-hospital survivors after requiring mechanical circulatory support, with either extracorporeal membrane oxygenation or ventricular assist devices. Data was collected regarding these patients' general health, cardiac status, and neurologic outcome, and compared between the two modes of support.
Results:
Follow-up was available for 26 patients supported with extracorporeal membrane oxygenation (25 survivors, 96%) and 11 patients supported with ventricular assist devices (10 survivors, 91%); median follow-up 42 months, 11 to 92 months). More than 80% of survivors were in New York Heart Association class I or II. Of 31 patients for whom neurologic assessment data was available, moderate to severe neurologic impairment was more common for extracorporeal membrane oxygenation supported patients [13 of 21, 59%) than for ventricular assist device supported patients (2 of 10, 20% p = 0.03). Neurologic impairment was associated with small patient size and the use of circulatory arrest during cardiac surgical repair, but was not associated with in-hospital neurologic complications, carotid cannulation, or presupport cardiac arrest.
Conclusions:
The long-term survival and cardiac functional status of pediatric cardiac patients requiring mechanical circulatory support is favorable. Extracorporeal membrane oxygenation supported patients demonstrate higher rates of neurologic impairment than patients supported with ventricular assist devices. Poor neurologic outcomes are associated with institution of support in younger patients with more complex congenital heart disease.