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- W4220899069 abstract "The use of mechanical circulatory support (MCS) in the pediatric population has evolved significantly in the past 20 years, but its management still poses several challenges. We aim to describe patient characteristics, outcomes, and morbidity associated with different modalities of MCS, in a tertiary center. Retrospective analysis of data from all the children who underwent MCS between 2002 and 2018 at a pediatric cardiology unit. Between 2002 and 2018, 22 devices were implanted in 20 patients. Patients were divided into three groups: Group A (n=11) extracorporeal membrane oxygenator (ECMO); Group B (n=8) pulsatile paracorporeal ventricular assist device (VAD) and group C (n=3) paracorporeal continuous flow VAD. The median age was similar in groups A and B (18 and 23 months, respectively), and higher in group C (13 years). ECMO patients were cannulated mainly as a bridge to recovery (post cardiotomy- 8) while group B and C patients were bridged to transplantation. The most frequent complications were bleeding (group A - 36%, group C - 66.6%) and thromboembolic events (group B - 50%, group C - 33.3%). As for outcomes, in group A the majority of patients (54.5%) were weaned and 27.3% died. Half of group B and all of group C patients underwent transplantation. Bleeding and thromboembolic events were the main complications observed. Group B showed the highest mortality, probably related to the low weight of the patients. Overall, outcomes and complications are related to the type of device and patient status and characteristics. Nos últimos 20 anos ocorreu uma grande evolução no uso de dispositivos de assistência circulatória mecânica (ACM) na idade pediátrica embora persistam grandes desafios no seu manejo. O objetivo deste trabalho é descrever as características dos doentes, resultados e morbilidade associada a diferentes modalidades de ACM, num centro terciário. Análise retrospetiva de doentes que necessitaram de ACM entre 2002 e 2018 numa unidade de cardiologia pediátrica. Vinte e dois dispositivos foram implantados em vinte doentes, entre 2002 e 2018. Grupo A (n=11) Extracorporeal Membrane Oxygenator (ECMO); Grupo B (n=8) Assistência ventricular paracorporal pulsátil (AVPP); Grupo C (n=3) Assistência ventricular paracorporal de fluxo contínuo (AVPFC). A mediana de idades foi semelhante no grupo A e B (18 e 23 meses, respetivamente) e superior no grupo C (13 anos). A ACM foi maioritariamente usada como ponte para recuperação no grupo A (pós-cardiotomia -8) e ponte para transplante no grupo B e C. As complicações mais frequentes foram hemorragia (grupo A - 36%, grupo C - 66,6%) e eventos tromboembólicos (grupo B - 50%, grupo C - 33,3%). No grupo A, a assistência foi removida após recuperação em 54,5% dos casos e 27,3% faleceram. Nos grupos B e C, metade e todos os doentes foram transplantados, respetivamente. A hemorragia e os eventos tromboembólicos foram as principais complicações observadas. No grupo B verificou-se a taxa de mortalidade mais elevada, provavelmente relacionado com a reduzido peso dos doentes e tipo de ACM. Em suma, os resultados e as complicações dependem das características dos doentes e do tipo de assistência implantada." @default.
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- W4220899069 date "2022-05-01" @default.
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- W4220899069 title "Mechanical circulatory support in children: Strategies, challenges and future directions" @default.
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- W4220899069 doi "https://doi.org/10.1016/j.repc.2021.03.011" @default.
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