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DOI: 10.1055/s-2005-862087
Efficacy of mechanical cardiac assist devices in a congenital cardiac surgery program
Objectives: We report on our experience with mechanical circulatory support in our congenital cardiac surgery program.
Material and Methods: Since 1992, 39 patients had mechanical circulatory support. Extracorporeal membrane oxygenation (ECMO) was applied in 28 patients, median age: 1.8 months (2 days –23 years), median weigth: 3.9 (2.7–87)kg. Ventricular assist devices (VAD) were used in 11 patients (3 Novacor, 6 Medos, 2 Berlin Heart), median age: 9.5 (0.7–19.9) years; (p=0.000), median weight: 28 (5.9–75)kg; (p=0.000. Indication for ECMO was recovery (25) or emergent establishment of support in patients waiting for transplantation (3, 2 switched to VAD). Indication for VAD was bridge to transplant in all but one
Results: Mean duration of ECMO support was 4.1±3.2 (0.5–13) days. Fourteen patients (57%) were successfully weaned, 4 (14%) switched to VAD or transplanted and overall 46% of patients were discharged home. Mean duration of VAD was 13.8±10.3 (0.2–28) days. Neurologic sequaele were present in 2 patients (18%). Five patients (45%) were successfully transplanted and overall 6 (55%) were discharged home. After a follow-up of 2.5±2.3years (ECMO) and 6.1±4.2 years (VAD) there is one late mortality (VAD). All survivors are clinically well.
Conclusions: Mechanical circulatory support reduces mortality to about 50% in pediatric patients who would otherwise not survive either open heart surgery or myocardial failure until transplantation. ECMO is suitable for postcardiotomie patients and may serve as emergent bridge to VAD. It should therefore be available in any congenital cardiovascular surgical program.