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Pediatric circulatory support
A Sidiropoulos1, H Hotz, W Konertz
1Department of Cardiac Surgery, Charité, Berlin, Germany. sidial@rz.charite.hu-berlin.de
Insights
Mechanical circulatory support for pediatric patients is challenging. A pulsatile system showed feasibility and effectiveness, with centrifugal pumps as an alternative for extracorporeal support.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Mechanical circulatory support (MCS) remains a critical challenge in infants and small children.
- Technological advancements in MCS have historically focused on adult populations.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of mechanical circulatory support systems in pediatric patients.
- To assess outcomes of pulsatile circulatory support and centrifugal pumps in infants and children.
Main Methods:
- A retrospective analysis of 10 pediatric patients (4 days to 8 years) treated with cardiac assist systems between 1994 and 1996.
- Utilized pulsatile circulatory support systems (8 patients) and centrifugal pumps (2 patients).
- Indications included bridge to transplantation, postcardiotomy failure, and cardiogenic shock.
Main Results:
- Median duration of support was 4 days, with observed recovery of renal, hepatic, and cardiac function post-implantation.
- Six patients survived, discharged after transplantation or myocardial recovery.
- Mortality in 4 cases was attributed to bleeding and multiorgan failure; no technical failures were reported.
Conclusions:
- Pulsatile circulatory support systems are feasible and effective for pediatric extracorporeal support.
- Centrifugal pumps serve as a viable alternative when anatomical conditions preclude pulsatile system implantation.
Background:
Mechanical circulatory support in infants and small children is still a crucial issue. Until recently technological advances have been limited to the adult population.
Methods:
Between February 1994 and December 1996, 553 infants or children underwent operation at our institution. Ten of them were treated with cardiac assist systems. Their ages ranged from 4 days to 8 years (median 5 months). In 8 patients we used a pulsatile circulatory support system available in 6 sizes (9, 10, 22.5, 25, 54, and 60 mL). A centrifugal pump was used in 2 additional infants. In 3 children cardiac assist was considered as a bridge to transplantation; in the remaining patients postcardiotomy failure or cardiogenic shock led to mechanical support.
Results:
Median duration of assist was 4 days (range 8 hours to 17 days). In all cases we could observe recovery of renal, hepatic, and cardiac function in the immediate postimplantation period. Six patients survived and could be discharged either after successful transplantation or after myocardial recovery from postcardiotomy failure. The cause of death in 4 cases was bleeding and multiorgan failure. No technical failures occurred with either system.
Conclusions:
The pulsatile circulatory support system seems to be feasible and effective for pediatric extracorporeal support. If the anatomic situation does not permit implantation, centrifugal pumps are an alternative.