TY - JOUR
T1 - Mechanical circulatory support after paediatric heart transplantation
AU - Perri, Gianluigi
AU - Hasan, Asif
AU - Cassidy, Jane
AU - Kirk, Richard
AU - Haynes, Simon
AU - Smith, John
AU - Crossland, David
AU - Griselli, Massimo
PY - 2012/10
Y1 - 2012/10
N2 - Objectives: Mechanical circulatory support (MCS) may be required after orthotopic heart transplantation (OHTx) in children for the treatment of failure or rejection. We review the incidence and outcomes of post-transplant MCS in our institution. Methods: MCS was classified as early (<1 month since transplant) or late (>1 month since transplant) and the support offered was either veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) or a ventricular assist device (VAD). From 2003 to the present, 100 children (<16 years) underwent OHTx. Fifteen (15%) had 17 episodes of MCS. MCS was instituted early in 10 and late in seven episodes. Two children required two episodes of support. VA-ECMO was used in 12 episodes (71%). Two children required VAD support alone (12%). In three (17%) episodes ECMO was subsequently converted from VAD. Results: Among 10 children with early failure, eight were successfully weaned from support with recovery of graft function. In the late failure group, three of six patients died. All but four patients underwent re-transplantation with no perioperative deaths. Overall survival to discharge was 66%. The early failure group shows a better survival rate to hospital discharge compared with the late failure group (78 vs 50%; P < 0.0001). Conclusions: The incidence of post-transplant MCS for graft failure in our patients was 15%. Early graft failure has a better outcome than late failure. Re-transplantation has good mid-term outcomes in children. A stepwise approach with a multimodality MCS strategy improves survival in this group of patients.
AB - Objectives: Mechanical circulatory support (MCS) may be required after orthotopic heart transplantation (OHTx) in children for the treatment of failure or rejection. We review the incidence and outcomes of post-transplant MCS in our institution. Methods: MCS was classified as early (<1 month since transplant) or late (>1 month since transplant) and the support offered was either veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) or a ventricular assist device (VAD). From 2003 to the present, 100 children (<16 years) underwent OHTx. Fifteen (15%) had 17 episodes of MCS. MCS was instituted early in 10 and late in seven episodes. Two children required two episodes of support. VA-ECMO was used in 12 episodes (71%). Two children required VAD support alone (12%). In three (17%) episodes ECMO was subsequently converted from VAD. Results: Among 10 children with early failure, eight were successfully weaned from support with recovery of graft function. In the late failure group, three of six patients died. All but four patients underwent re-transplantation with no perioperative deaths. Overall survival to discharge was 66%. The early failure group shows a better survival rate to hospital discharge compared with the late failure group (78 vs 50%; P < 0.0001). Conclusions: The incidence of post-transplant MCS for graft failure in our patients was 15%. Early graft failure has a better outcome than late failure. Re-transplantation has good mid-term outcomes in children. A stepwise approach with a multimodality MCS strategy improves survival in this group of patients.
KW - Extracorporeal membrane oxygenation
KW - Mechanical circulatory support
KW - Paediatric heart transplantation
KW - Ventricular assist device
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U2 - 10.1093/ejcts/ezs115
DO - 10.1093/ejcts/ezs115
M3 - Article
C2 - 22433200
AN - SCOPUS:84873140932
SN - 1010-7940
VL - 42
SP - 696
EP - 701
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 4
M1 - ezs115
ER -