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

Abstract

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.

Pediatric Mechanical Circulatory Support Systems in Latin America

“…Due to the economic constraints imposed by our public health system, we have used only short‐term devices to support these patients. We increased the survival ratio to transplantation and to hospital discharge by using centrifugal pumps with apical cannulation as a short‐term MCS . The same approach has been used by the Fundación Cardiovascular de Colombia since 2010.…”

Circulatory Support as a Bridge to Pediatric Heart Transplantation

“…The article "Use of short-term circulatory support as a bridge in pediatric transplantation", recently published 1 in Arquivos Brasileiros de Cardiologia has aroused great interest.…”

“…Caneo et al 1 published the largest national experience with the use of circulatory support in children. The authors, according to the reported experience, demonstrated that the use of ventricular assist devices increased the possibility for children in cardiogenic shock to undergo transplantation, although mortality outcomes remained very high, according to international experiences.…”

“…About the risk stratification, for instance, Caneo et al 1 grouped patients in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 and 2 in the same category, which certainly results in differences in shock severity and therapeutic response.…”

“…It is absolutely necessary that the child have time for correction of multiple-organ dysfunction prior to the transplantation. Caneo et al 1 had a mean time of 19 days to perform the transplantation in the group undergoing mechanical circulatory assistance, but one patient was transplanted within 6 hours! How do the authors manage the assisted child in relation to maintenance or not in the transplant waiting list?…”