Mechanical circulatory support after paediatric heart transplantation

Gianluigi Perri, Asif Hasan, Jane Cassidy, Richard Kirk, Simon Haynes, John Smith, David Crossland, Massimo Griselli

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article numberezs115
Pages (from-to)696-701
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume42
Issue number4
DOIs
StatePublished - Oct 1 2012

Keywords

  • Extracorporeal membrane oxygenation
  • Mechanical circulatory support
  • Paediatric heart transplantation
  • Ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Perri, G., Hasan, A., Cassidy, J., Kirk, R., Haynes, S., Smith, J., Crossland, D., & Griselli, M. (2012). Mechanical circulatory support after paediatric heart transplantation. European Journal of Cardio-thoracic Surgery, 42(4), 696-701. [ezs115]. https://doi.org/10.1093/ejcts/ezs115