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Experience with uni- (LVAD) and biventricular (ECMO) circulatory support in postcardiotomy pediatric patients
1Clinic of Heart Surgery, University of Cologne, Germany.
Insights
Uni- and biventricular assist systems effectively managed pediatric postcardiotomy low-output syndrome. While both circulatory support methods showed promise, Extracorporeal Membrane Oxygenation (ECMO) presented a higher complication rate than Left Ventricular Assist Device (LVAD) support.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Postoperative low-output syndrome (LOS) is a critical complication in pediatric cardiac surgery.
- Mechanical circulatory support (MCS) is essential for managing severe pediatric LOS.
- Centrifugal pump-based assist devices offer potential solutions for pediatric MCS.
Purpose of the Study:
- To evaluate the safety and efficacy of uni- (LVAD) and biventricular (ECMO) assist systems in pediatric patients with postcardiotomy LOS.
- To compare the outcomes and complication rates between LVAD and ECMO support in this population.
- To discuss the characteristics of these support systems based on global experience.
Main Methods:
- Retrospective analysis of six pediatric patients with postcardiotomy LOS.
- Application of Biomedicus centrifugal pump for LVAD and ECMO support.
- Monitoring of vital organ functions during circulatory support.
- Review of worldwide experience with similar support systems.
Main Results:
- One patient supported with LVAD and one with ECMO survived.
- Analysis of vital organ functions revealed varying responses to support.
- ECMO was applied in five children (3 days to 16 years); LVAD in one infant (16 months).
- Higher complication rates were observed with ECMO compared to LVAD.
Conclusions:
- Both LVAD and ECMO using Biomedicus centrifugal pumps can be safely applied for postcardiotomy LOS in pediatric patients, including neonates.
- LVAD support demonstrated a potentially safer profile with fewer complications than ECMO.
- ECMO represents a more aggressive approach for pediatric circulatory support.
Abstract:
In six pediatric patients with postoperative low-output-syndrome (LOS), uni-(LVAD) and biventricular (ECMO) assist systems with Biomedicus centrifugal pump were used. ECMO was applied in 5 children aged between 3 days and 16 years, one infant with an age of 16 months was implanted with LVAD. One patient from the ECMO-group and the patient with LVAD-support survived. Analysis of vital organ functions during ECMO and LVAD support are presented and characteristics of both support systems for use in pediatric patients with postcardiotomy LOS based on worldwide experience discussed. In conclusion, both, uni- (LVAD) and biventricular circulatory support (ECMO) using Biomedicus centrifugal pump can be safely applied for management of postcardiotomy LOS even in neonates, however, ECMO support in comparison to LVAD is a more aggressive approach associated with a higher complication rate.