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Mechanical circulatory support in children: Strategies, challenges and future directions
Susana Abreu1, Catarina Brandão1, Conceição Trigo1
1Pediatric Cardiology, Hospital de Santa Marta, Centro Hospital Universitário Lisboa Central, EPE, Lisboa, Portugal.
Insights
Pediatric mechanical circulatory support (MCS) management involves challenges. Outcomes and complications vary by device type (ECMO, VADs) and patient factors, with bleeding and thromboembolic events being common.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiothoracic Surgery
Background:
- Mechanical circulatory support (MCS) in pediatric patients has advanced significantly over the last two decades.
- Despite advancements, the management of pediatric MCS presents ongoing challenges.
- This study examines patient characteristics, outcomes, and morbidity across different pediatric MCS modalities.
Purpose of the Study:
- To describe patient demographics, clinical outcomes, and complications associated with various mechanical circulatory support devices in children.
- To compare the efficacy and safety of extracorporeal membrane oxygenation (ECMO), pulsatile paracorporeal ventricular assist devices (VADs), and continuous flow VADs in a pediatric tertiary care setting.
Main Methods:
- A retrospective analysis was conducted on all pediatric patients who received MCS between 2002 and 2018.
- Patients were categorized into three groups based on the device used: ECMO, pulsatile paracorporeal VAD, and continuous flow VAD.
- Data collected included patient characteristics, device type, indication for support, complications, and outcomes.
Main Results:
- Twenty-two devices were implanted in 20 pediatric patients during the study period.
- Extracorporeal membrane oxygenation (ECMO) was primarily used as a bridge to recovery, while VADs served as a bridge to transplantation.
- Common complications included bleeding (36-66.6%) and thromboembolic events (33.3-50%), with Group B (pulsatile VAD) showing the highest mortality.
Conclusions:
- Bleeding and thromboembolic events are significant complications in pediatric MCS.
- Mortality rates and outcomes are influenced by the specific type of MCS device and individual patient characteristics, including weight.
- Tailoring MCS device selection and management to patient status is crucial for optimizing outcomes in pediatric cardiac care.
Introduction:
The use of mechanical circulatory support (MCS) in the pediatric population has evolved significantly in the past 20 years, but its management still poses several challenges. We aim to describe patient characteristics, outcomes, and morbidity associated with different modalities of MCS, in a tertiary center.
Methods:
Retrospective analysis of data from all the children who underwent MCS between 2002 and 2018 at a pediatric cardiology unit.
Results:
Between 2002 and 2018, 22 devices were implanted in 20 patients. Patients were divided into three groups: Group A (n=11) extracorporeal membrane oxygenator (ECMO); Group B (n=8) pulsatile paracorporeal ventricular assist device (VAD) and group C (n=3) paracorporeal continuous flow VAD. The median age was similar in groups A and B (18 and 23 months, respectively), and higher in group C (13 years). ECMO patients were cannulated mainly as a bridge to recovery (post cardiotomy- 8) while group B and C patients were bridged to transplantation. The most frequent complications were bleeding (group A - 36%, group C - 66.6%) and thromboembolic events (group B - 50%, group C - 33.3%). As for outcomes, in group A the majority of patients (54.5%) were weaned and 27.3% died. Half of group B and all of group C patients underwent transplantation.
Conclusion:
Bleeding and thromboembolic events were the main complications observed. Group B showed the highest mortality, probably related to the low weight of the patients. Overall, outcomes and complications are related to the type of device and patient status and characteristics.
