Rational Use of Mechanical Circulatory Support as a Bridge to Pediatric and Congenital Heart Transplantation

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art_MIANA_Rational_Use_of_Mechanical_Circulatory_Support_as_a_2018.PDF (372.64 KB)
Citações na Scopus
1
Tipo de produção
article
Data de publicação
2018
DOI
SciELO
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
SOC BRASIL CIRURGIA CARDIOVASC
Autores
Citação
BRAZILIAN JOURNAL OF CARDIOVASCULAR SURGERY, v.33, n.3, p.242-249, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Introduction: Donor shortage and organ allocation is the main problem in pediatric heart transplant. Mechanical circulatory support is known to increase waiting list survival, but it is not routinely used in pediatric programs in Latin America. Methods: All patients listed for heart transplant and supported by a mechanical circulatory support between January 2012 and March 2016 were included in this retrospective single-center study. The endpoints were mechanical circulatory support time, complications, heart transplant survival and discharge from the hospital. Results: Twenty-nine patients from our waiting list were assessed. Twelve (45%) patients were initially supported by extracorporeal membrane oxygenation (ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five patients initially supported by ECMO were bridged to another device. One was bridged to a centrifugal pump and four were bridged to Berlin Heart Excor (R). Among the 29 supported patients, 18 (62%) managed to have a heart transplant. Thirty-day survival period after heart transplant was 56% (10 patients). Median support duration was 12 days (interquartile range [IQR] 4-26 days) per run and the waiting time for heart transplant was 9.5 days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality predictor (OR=22.6 [CI=1.04-494.6]; P=0.04). Conclusion: Mechanical circulatory support was able to bridge most INTERMACS 1 and 2 pediatric patients to transplant with an acceptable complication rate. Acute renal failure increased mortality after mechanical circulatory support in our experience.
Palavras-chave
Heart Transplantation, Heart Defects, Congenital, Heart-Assist Devices, Heart Failure/Therapy
URI
https://observatorio.fm.usp.br/handle/OPI/27956
Referências
  1. Adachi I, 2015, J THORAC DIS, V7, P2194, DOI 10.3978/j.issn.2072-1439.2015.12.61
  2. Andrews RE, 2008, CIRCULATION, V117, P79, DOI 10.1161/CIRCULATIONAHA.106.671735
  3. Azeka E, 2014, ARQ BRAS CARDIOL, V103, P1, DOI 10.5935/abc.2014S005
  4. Blume ED, 2016, J HEART LUNG TRANSPL, V35, P578, DOI 10.1016/j.healun.2016.01.1227
  5. Caneo LF, 2016, ARTIF ORGANS, V40, P925, DOI 10.1111/aor.12816
  6. Caneo LF, 2015, REV BRAS CIR CARDIOV, V30, P657, DOI 10.5935/1678-9741.20150088
  7. Caneo LF, 2015, ARQ BRAS CARDIOL, V104, P78, DOI 10.5935/abc.20140165
  8. Cassidy J, 2013, J HEART LUNG TRANSPL, V32, P1101, DOI 10.1016/j.healun.2013.08.003
  9. Dipchand A, 2005, CAN J CARDIOL, V21, P1145
  10. Dipchand AI, 2013, J HEART LUNG TRANSPL, V32, P979, DOI 10.1016/j.healun.2013.08.005
  11. Gandolfo F, 2014, ANN CARDIOTHORAC SUR, V3, P507, DOI 10.3978/j.issn.2225-319X.2014.08.25
  12. Hetzer R, 2006, ANN THORAC SURG, V82, P917, DOI 10.1016/j.athoracsur.2006.03.065
  13. Jatene MB, 2008, ARQ BRAS CARDIOL, V90, P360, DOI 10.1590/S0066-782X2008000500010
  14. Lequier L, 2015, PEDIATR CRIT CARE ME, V16, P87, DOI 10.1097/PCC.0000000000000298
  15. Lipshultz SE, 2003, NEW ENGL J MED, V348, P1647, DOI 10.1056/NEJMoa021715
  16. Miana LA, 2015, REV BRAS CIR CARDIOV, V30, P409, DOI 10.5935/1678-9741.20150053
  17. Miana LA, 2014, REV BRAS CIR CARDIOV, V29, P322, DOI 10.5935/1678-9741.20140106
  18. Moreno Guillermo E., 2014, Arch. Cardiol. Méx., V84, P256, DOI 10.1016/j.acmx.2013.12.009
  19. Nugent AW, 2003, NEW ENGL J MED, V348, P1639, DOI 10.1056/NEJMoa021737
  20. Rossano JW, 2015, KOREAN CIRC J, V45, P1, DOI 10.4070/kcj.2015.45.1.1
  21. Sandica E, 2016, ARTIF ORGANS, V40, P225, DOI 10.1111/aor.12552
  22. Stiller B, 2005, EUR J CARDIO-THORAC, V28, P234, DOI 10.1016/j.ejcts.2005.04.023
  23. Sutherland SM, 2015, CLIN J AM SOC NEPHRO, V10, P554, DOI 10.2215/CJN.01900214
  24. Wehman B, 2016, ANN THORAC SURG, V101, P2321, DOI 10.1016/j.athoracsur.2015.12.003

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/08
Artigos e Materiais de Revistas Científicas - LIM/11