Extracorporeal membrane oxygenation in patients undergoing superior cavopulmonary anastomosis

Jolley, Matthew A.; Thiagarajan, Ravi R.; Barrett, Cindy; Salvin, Joshua W.; Cooper, David S.; Rycus, Peter; Teele, Sarah A.

doi:10.1016/j.jtcvs.2014.04.028

Cited by 60 publications

(53 citation statements)

References 19 publications

(27 reference statements)

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“…Patients after Stage I palliation had extremely poor outcomes (11% survival), whereas those after Stage II and Stage III did significantly better, with survival reaching 60%. Survival rates with VAD support for Stage II (58%) and Stage III (60%) are still better than previously reported outcomes for ECMO support in single-ventricle physiology (Stage II [41%]15 and Stage III [35%]16). The type of VAD used for single-ventricle physiology may also have an important clinical impact on outcome.…”

Section: Current Challengesmentioning

confidence: 60%

Pediatric ventricular assist devices: current challenges and future prospects

Bürki¹,

Adachi²

2017

VHRM

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The field of mechanical circulatory support has made great strides in the preceding 2 decades. Although pediatric mechanical circulatory support has lagged behind that of adults, the gap between them is expected to close soon. The only device currently approved by the US Food and Drug Administration for use in children is the Berlin Heart EXCOR ventricular assist device (VAD). The prospective Berlin Heart Investigational Device Exemption Trial demonstrated good outcomes, such as bridge to transplantation or recovery, in ~90% of children supported with this device. However, a high incidence of hemorrhagic and thrombotic complications was also noted. As a result, pediatric centers have just started implanting adult intracorporeal continuous-flow devices in children. This paradigm shift has opened a new era in pediatric mechanical circulatory support. Whereas children on VAD were previously managed exclusively in hospital, therapeutic options such as outpatient management and even destination therapy have been becoming a reality. With continued miniaturization and technological refinements, devices currently in development will broaden the range of options available to children. The HeartMate 3 and HeartWare MVAD are two such compact VADs, which are anticipated to have great potential for pediatric use. Additionally, a pediatric-specific continuous-flow VAD, the newly redesigned Jarvik Infant 2015, is currently undergoing preclinical testing and is expected to undergo a randomized clinical trial in the near future. This review aims to discuss the challenges posed by the use of intracorporeal adult continuous-flow devices in children, as well as to provide our perspective on the future prospects of the field of pediatric VADs.

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Section: Current Challengesmentioning

confidence: 60%

Pediatric ventricular assist devices: current challenges and future prospects

Bürki¹,

Adachi²

2017

VHRM

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“…7 Recently published query of 103 BDG patients using Extracorporeal Life Support Organization registry found more encouraging results, with 41% of patients surviving to hospital discharge. 8 Our patient's ECMO course was uncomplicated. Improved systemic oxygenation enabled stabilization and opportunity for surgical intervention.…”

Section: Discussionmentioning

confidence: 75%

Transhepatic Cannulation for Venovenous Extracorporeal Membrane Oxygenation

Rhodes

Sasser²,

McMahon³

et al. 2015

ASAIO Journal

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Limited vascular access because of vessel injury or thrombosis may complicate care of children with congenital heart disease. Although transhepatic venous access for cardiac catheterization and central venous catheter placement has been used in children, its use for extracorporeal membrane oxygenation (ECMO) has not been described. We report successful use of transhepatic cannulation for venovenous ECMO to support a 15 month-old child with bidirectional Glenn anatomy and intractable hypoxemia.

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“…Recent report on the usage of VA-ECMO in SCPC showed an improved survival to hospital discharge (41%) compared to earlier data, but there was still a high incidence of neurological complications (32). There have been several reports of VAD use with a SCPC palliation as single cases (14, 33, 34).…”

Section: Mechanical Circulatory Support Typementioning

confidence: 84%

“…This is beneficial as it can be used as a bridge to decision in order to allow full assessment of each major organ system. However, the associated substantial neurological risks are an important consideration (24, 32). Therefore, assessment of the central nervous system (CNS) is critical prior to implantation of a more durable MCS in cases where VA-ECMO is used for acute deteriorations.…”

Section: Discussionmentioning

confidence: 99%

“…Since the SVC is connected to the pulmonary artery, decompression of the systemic pumping chamber may not guarantee adequate venous drainage and may result in ongoing venous hypertension, which encourages the development of aberrant veno-venous connections and subsequently worsening cyanosis. Thus the management of circulatory failure at SCPC palliation is mainly medical management, either to recovery or as a bridge to OHTx, with conversion to total cavo-pulmonary circulation or to biventricular repair on rare occasions and subsequent central VA-ECMO or VAD support (14, 32). Particularly, in acute failure it is preferred to use VA-ECMO or VAD, while the therapeutics options for chronic failure are VAD or OHTx.…”

Section: Mechanical Circulatory Support Typementioning

confidence: 99%

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Mechanical Circulatory Support for Single Ventricle Failure

Griselli

Sinha

Jang

et al. 2018

Front. Cardiovasc. Med.

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Mechanical circulatory support (MCS) for failing single ventricle (SV) physiology is a complex and challenging problem, which has not yet been satisfactorily addressed. Advancements in surgical strategies and techniques along with intensive care management have substantially improved the outcomes of neonatal palliation for SV physiology, particularly for hypoplastic left heart syndrome (HLHS). This is associated with a steady increase in the number of SV patients who are susceptible to develop heart failure (HF) and would potentially require MCS at a certain stage in their palliation. We have reviewed the literature regarding the reported modalities of MCS use in the management of SV patients. This includes analysis of various devices and strategies used for failing circulation at distinct stages of the SV pathway: after neonatal palliation, after the superior cavo-pulmonary connection (SCPC), and after total cavo-pulmonary connection (TCPC).

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Extracorporeal membrane oxygenation in patients undergoing superior cavopulmonary anastomosis

Abstract: Mortality in infants with Glenn physiology supported with ECMO is lower than that previously reported, but the incidence of neurologic injury is high. These data support use of ECMO in patients with Glenn physiology with refractory cardiopulmonary failure.

Cited by 60 publications

References 19 publications

Pediatric ventricular assist devices: current challenges and future prospects

Pediatric ventricular assist devices: current challenges and future prospects

Transhepatic Cannulation for Venovenous Extracorporeal Membrane Oxygenation

Mechanical Circulatory Support for Single Ventricle Failure

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