在失败的双向格伦生理学中改善机械循环支持的结果
Ryan L Kobayashi1, Ryan J Williams2, Kimberlee Gauvreau2
1Departments of Cardiology and Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. Ryan.Kobayashi@cardio.chboston.org.
Pediatric cardiology
|July 19, 2024
概括
在失败的双向格伦 (BDG) 生理学中,机械循环支持 (MCS) 显示出更好的结果. 一个分阶段的策略和比瓦利鲁丁抗凝剂减少了儿科患者的不良事件和增加了移植率.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 心血管外科心血管外科
- 关键护理医学 关键护理医学
背景情况:
- 机械循环支持 (MCS) 与双向格伦 (BDG) 生理学失败的患者的高发病率和死亡率有关.
- 优化MCS策略对于改善这一复杂儿科患者群体的结果至关重要.
研究的目的:
- 评估改变MCS策略和抗凝药对患有BDG生理学的儿童结局的影响.
- 为了比较2018年之前和之后的结果,重点关注移植率和血红相容性相关的不良事件.
主要方法:
- 对14名患有BDG生理学需要MCS的儿科患者的回顾性分析.
- 两个队列的比较:2018年之前 (可变抗凝剂,多样化的MCS) 和2018年后 (分阶段支持,比瓦利鲁丁).
- 移植率的评估,支持的持续时间,以及与血红相容性相关的重大不良事件 (MHRAE).
主要成果:
- 2018年后的队列 (n=7) 与2018年之前的队列 (n=7) 相比,移植率有所改善 (71%对43%).
- 在2018年后的组中,总患者支持日数显著增加 (1260 vs. 536天).
- 2018年后,与血液相容性相关的重大不良事件发生率大幅降低 (每100个患者月中有24个,而不是63个).
结论:
- 一个分阶段的MCS策略 (ECMO到脉动性VAD) 与比瓦利鲁丁抗凝剂相结合,在患有BDG生理学的儿科患者中改善了生存率并减少了不良事件.
- 这些发现表明,精细的MCS协议可以提高结果,尽管这种心脏病的固有挑战.
- 进一步研究优化的抗凝血和设备策略是为这个脆弱人群的必要.
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