Transplante cardíaco pediátrico em vigência de choque cardiogênico refratário: análise crítica da viabilidade, aplicabilidade e resultados

Jatene, Marcelo Biscegli; Miana, Leonardo Augusto; Pessoa, Alexander John; Riso, Arlindo; Azeka, Estela; Tanamati, Carla; Gimenez, Solange Coppola; Lopes, Antônio Augusto; Marcial, Miguel Barbero; Na, Stolf

doi:10.1590/s0066-782x2008000500010

Cited by 9 publications

(8 citation statements)

References 19 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, our mortality rate in the priority list was high, as we already demonstrated in 2008, when we studied patients with cardiogenic shock [ 9 ] . This is due to the obvious severity of the disease and donor shortage for pediatric patients, especially, when HTx needs to be performed on an emergency basis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric and Congenital Heart Transplant: Twenty-year Experience in a Terciary Brazilian Hospital

Miana¹,

Azeka²,

Canêo³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

Self Cite

View full text Add to dashboard Cite

IntroductionCardiac transplantation remains the gold standard for end-stage cardiomyopathies and congenital heart defects in pediatric patients.ObjectiveThis study aims to report on 20 years of experience since the first case and evaluate our results.MethodsWe conducted a retrospective analysis of the database and outpatient follow-up. Between October 1992 and April 2012, 109 patients underwent 114 transplants. 51.8% of them being female. The age of patients ranged from 12 days to 21 years with a mean of 8.8±5.7 years and a median of 5.2 years. The underlying diagnosis was dilated cardiomyopathy in 61.5%, congenital heart disease in 26.6% and restrictive cardiomyopathy in 11.9%. All patients above 17 years old had congenital heart disease.ResultsSurvival rate at 30 days, 1, 5, 10, 15, and 20 years were 90.4%, 81.3%, 70.9%, 60.5%, 44.4% and 26.7%, respectively. Mean cold ischemic time was 187.9 minutes and it did not correlate with mortality (P>0.05). Infectious complications and rejection episodes were the most common complications (P<0.0001), occurring, respectively, in 66% and 57.4% of the survivors after 10 years. There was no incidence of graft vascular disease and lymphoproliferative disease at year one, but they affected, respectively, 7.4% and 11% of patients within 10 years.ConclusionTwenty-year pediatric heart transplant results at our institution were quite satisfactory and complication rates were acceptable.

show abstract

Section: Discussionmentioning

confidence: 99%

“…We have several publications in this area, from 1996, when we published our initial experience [ 3 , 5 - 8 ] , to our two most recent studies, one addressing the results of HTx in patients with cardiogenic shock [ 9 ] and another in patients with rejection and cyclosporine intolerance [ 10 ] .…”

Section: Introductionmentioning

confidence: 99%

Pediatric and Congenital Heart Transplant: Twenty-year Experience in a Terciary Brazilian Hospital

Miana¹,

Azeka²,

Canêo³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

Self Cite

View full text Add to dashboard Cite

show abstract

“…Heart transplantation (HTx) is increasingly accepted as the gold-standard treatment for end stage heart disease (either functional, anatomic or both) in the pediatric and adult congenital population [ 5 , 6 ] . Donor shortage and difficulties in allocation increase mortality during the waiting list for transplantation, specifically in low-weight receptors, and high-risk congenital heart and cardiomyopathy patients that develop cardiogenic shock [ 7 ] .…”

Section: Introductionmentioning

confidence: 99%

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

Miana¹,

Silva²,

Canêo³

et al. 2018

Braz J Cardiovasc Surg

Self Cite

View full text Add to dashboard Cite

IntroductionDonor 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.MethodsAll 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.ResultsTwenty-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®. 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).ConclusionMechanical 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.

show abstract

“…The difficulty of identifying heart failure in children causes many to visit our emergency units for the very first time in very advanced stages of the disease. These patients or patients whose status worsened and required vasoactive drugs and ventilator support and had liver and kidney dysfunction (INTERMACS 1 and 2 according to the classification of Interagency Registry for Mechanically Assisted Circulatory Support; Table 1 ) should be hemodynamically compensated to reverse organ failure before the patients are subjected to HTX 1 . Often, isolated clinical measures are not sufficient, and mortality in these patients awaiting HTX surpasses 90% over 30 days 1 .…”

Section: Introductionmentioning

confidence: 99%

Use of Short-term Circulatory Support as a Bridge in Pediatric Heart Transplantation

Canêo¹,

Miana²,

Tanamati³

et al. 2014

Arquivos Brasileiros De Cardiologia

Self Cite

View full text Add to dashboard Cite

BackgroundHeart transplantation is considered the gold standard therapy for the advanced heart failure, but donor shortage, especially in pediatric patients, is the main limitation for this procedure, so most sick patients die while waiting for the procedure.ObjectiveTo evaluate the use of short-term circulatory support as a bridge to transplantation in end-stage cardiomyopathy.MethodsRetrospective clinical study. Between January 2011 and December 2013, 40 patients with cardiomyopathy were admitted in our Pediatric Intensive Care Unit, with a mean age of 4.5 years. Twenty patients evolved during hospitalization with clinical deterioration and were classified as Intermacs 1 and 2. One patient died within 24 hours and 19 could be stabilized and were listed. They were divided into 2 groups: A, clinical support alone and B, implantation of short-term circulatory support as bridge to transplantation additionally to clinical therapy.ResultsWe used short-term mechanical circulatory support as a bridge to transplantation in 9. In group A (n=10), eight died waiting and 2 patients (20%) were transplanted, but none was discharged. In group B (n=9), 6 patients (66.7%) were transplanted and three were discharged.The mean support time was 21,8 days (6 to 984h). The mean transplant waiting list time was 33,8 days. Renal failure and sepsis were the main complication and causeof death in group A while neurologic complications were more prevalent en group B.ConclusionMechanical circulatory support increases survival on the pediatric heart transplantation waiting list in patients classified as Intermacs 1 and 2.

show abstract

Transplante cardíaco pediátrico em vigência de choque cardiogênico refratário: análise crítica da viabilidade, aplicabilidade e resultados

Abstract: Children with cardiomyopathy and cardiogenic shock require immediate heart transplantation; only 57.1% could be transplanted, with an early 25% mortality rate. Those who survived transplantation showed good clinical progress, similar to that of children transplanted on an elective basis.

Cited by 9 publications

References 19 publications

Pediatric and Congenital Heart Transplant: Twenty-year Experience in a Terciary Brazilian Hospital

Pediatric and Congenital Heart Transplant: Twenty-year Experience in a Terciary Brazilian Hospital

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

Use of Short-term Circulatory Support as a Bridge in Pediatric Heart Transplantation

Contact Info

Product

Resources

About