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Post-cardiotomy mechanical circulatory support using a conventional bypass circuit in children
N C Patel1, M Jothi, D B Trivedi
1Department of Cardiac Surgery, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, UK.
Insights
Mechanical circulatory support (MCS) in children after cardiotomy offers good long-term survival (70%) and recovery. This approach using conventional bypass circuits can be favorable for selected pediatric patients.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Biomedical Engineering
Background:
- Mechanical circulatory support (MCS) is crucial for pediatric patients experiencing cardiotomy-induced heart failure when medical treatments are insufficient.
- Previous reports indicate challenges with overall survival and long-term outcomes in pediatric post-cardiotomy MCS.
Purpose of the Study:
- To evaluate the efficacy and outcomes of post-cardiotomy mechanical circulatory support using a conventional bypass circuit in pediatric patients.
- To assess the survival rates, complication profiles, and long-term quality of recovery in this patient cohort.
Main Methods:
- A retrospective analysis of 10 pediatric patients (median age 16 days) requiring MCS after cardiotomy over a 4.5-year period.
- Patients received MCS via a conventional bypass circuit, with support durations ranging from 26 to 146 hours.
Main Results:
- Seven out of ten patients survived hospitalization and were alive at a median follow-up of 18 months.
- Complications included renal failure (6/9), cerebrovascular events (3/9), and mediastinitis (2/9) in patients weaned from support.
- One patient was not weaned off support, and two patients died after successful weaning.
Conclusions:
- Post-cardiotomy mechanical circulatory support with conventional bypass circuits can lead to favorable outcomes in selected pediatric patients.
- Despite high initial complication rates, long-term survival (70%) and quality of recovery are generally good.
- Careful patient selection is essential for optimizing outcomes with this therapeutic approach.
Objective:
Mechanical circulatory support (MCS) is increasingly used after cardiotomy in children when conventional medical treatment fails. Poor overall survival and long-term outcome have been reported. We report our experience of post-cardiotomy MCS using a conventional bypass circuit.
Methods:
Over a 4 year and 6 month period 10 patients, with a median age of 16 days (range 5 days to 16 years) required MCS. Eight patients required support for failure to wean from cardiopulmonary bypass during primary correction. Two patients required support for cardiac arrest or poor cardiac output in the postoperative period.
Results:
The median duration of support was 43 h (range 26-146 h). Seven hospital survivors were alive and well at median follow-up of 18 months (range 4-36 months). One patient could not be weaned off support. Two more patients died after successful weaning from support. Complications in nine patients who could be weaned off support included renal failure (n=6), cerebrovascular events (n=3) and mediastinitis (n=2).
Conclusions:
Overall long-term survival (70%) and quality of recovery is usually good even though initial mortality and complication rates may be high. We think that post cardiotomy mechanical circulatory bypass using a conventional bypass circuit can offer a favourable outcome to selected patients.