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Resultados Mejorados con una Estrategia Gradual de Dispositivo de Asistencia Ventricular en Fisiología de Glenn: Una

Eitan Keizman¹, Emile A Bacha², Kerry Schindler³

¹Division of Cardiac Surgery, Department of Surgery, Columbia University, New York, New York; Pediatric and Congenital Cardiac Surgery Department, The Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.

The Journal of thoracic and cardiovascular surgery

|February 14, 2026

Resumen

Una estrategia escalonada de soporte circulatorio mecánico utilizando dispositivos centrífugos y oxigenadores, seguida de dispositivos pulsátiles, mejoró la supervivencia de los pacientes con circulación de Glenn en falla en espera de un trasplante de corazón.

Área de la Ciencia:

Cardiología; Cirugía Cardíaca Pediátrica; Soporte Circulatorio Mecánico

Sus antecedentes:

La fisiología de ventrículo único en falla en la etapa de Glenn bidireccional presenta desafíos significativos para el soporte circulatorio mecánico.
Históricamente, los resultados de los dispositivos de asistencia ventricular (VAD) en estos pacientes fueron deficientes debido a las dinámicas circulatorias únicas.
Datos multicéntricos recientes sugieren tasas de supervivencia en mejora en esta población.

Objetivo del estudio:

Evaluar los resultados de una estrategia gradual de VAD en pacientes con circulación de Glenn en falla.
Evaluar la eficacia del soporte centrífugo inicial con un oxigenador, seguido de la transición a un soporte pulsátil duradero.
Comparar las tasas de supervivencia con datos históricos.

Principales métodos:

Revisión de nueve pacientes consecutivos de Glenn que se sometieron a implante de VAD entre 2018 y 2025.
Uso inicial de dispositivos centrífugos temporales, con incorporación rutinaria de oxigenador en casos posteriores.
Conversión posterior a soporte pulsátil duradero (Berlin Heart EXCOR) para pacientes estables.
El resultado principal medido fue la supervivencia hasta el trasplante de corazón.

Principales resultados:

La edad media al momento del implante fue de 1.4 años; el 60% de los pacientes fueron trasplantados con éxito.
Siete pacientes (70%) pasaron a un soporte pulsátil duradero después del uso inicial de VAD centrífugo.
Los eventos adversos fueron comunes (mediana de 3 por paciente), incluyendo infección, sangrado y hemólisis.
Dos pacientes murieron mientras recibían soporte de VAD; dos permanecen vivos con soporte.

Conclusiones:

Una estrategia gradual de VAD, que incorpora soporte centrífugo temporal con oxigenadores y soporte pulsátil posterior, mejora la supervivencia en la circulación de Glenn en falla.
A pesar de los frecuentes eventos adversos, este enfoque une eficazmente a la mayoría de los pacientes de alto riesgo para el trasplante.
Se justifica una mayor validación en estudios multicéntricos más amplios para este grupo de pacientes desafiante.

Palabras clave:

Glenn VAD ventrículo único

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