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首页> 外文期刊>Artificial Organs >Outcomes with ventricular assist device versus extracorporeal membrane oxygenation as a bridge to pediatric heart transplantation.
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Outcomes with ventricular assist device versus extracorporeal membrane oxygenation as a bridge to pediatric heart transplantation.

机译：心室辅助装置与体外膜氧合作为小儿心脏移植的桥梁。

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Extracorporeal membrane oxygenation (ECMO) has long been the sole means of mechanical support for pediatric patients with end-stage cardiac failure, but has a high waitlist mortality and a reported survival to hospital discharge of less than 50%. The purpose of this study was to compare waitlist mortality and survival for ECMO versus ventricular assist device (VAD) support. A review was conducted of all patients listed for heart transplantation (HTx) since 2002 and requiring mechanical support. VAD support has been available from 2004 (Berlin Heart Excor Pediatrics). Competing risks analysis was used to model survival to one of four outcomes (HTx, death on waitlist, delisting, improvement). Thirty-six patients were on mechanical support while awaiting HTx (21 ECMO, 12 VAD, three both). Median age at listing was 1.2 years (birth-16.6 years) for ECMO and 11.3 years (0.3-14.6 years) for VAD. Diagnosis was cardiomyopathy in 33% for ECMO and 93% for VAD. Median time to HTx was 37 days (1-930) overall, 20 days (1-85) for ECMO, and 39 days (5-108) for VAD. Mechanical support was associated with increased odds of HTx (hazard ratio [HR] 2.4 [1.7-3.3], P < 0.0001) but also delisting or death waiting (HR 3.0 [1.1-7.8], P = 0.03). Waitlist mortality of 38% on ECMO was reduced to 13% with VAD use. Survival post-HTx to hospital discharge was better in the group on VAD support (92 vs. 80%). Pediatric patients requiring mechanical support as a bridge to HTx have short wait times but high waitlist mortality. Those patients who survived to be put on the Berlin Heart Excor Pediatric device based on individualized clinical decision making then had a lower waitlist mortality, a longer duration of support, and a higher survival to transplantation and hospital discharge.
机译：长期以来，体外膜氧合作用（ECMO）一直是终末期心力衰竭的儿科患者机械支持的唯一手段，但其候诊死亡率很高，据报道存活率不到50％。这项研究的目的是比较ECMO与心室辅助设备（VAD）支持的等待清单死亡率和生存率。自2002年以来对所有列为心脏移植（HTx）且需要机械支持的患者进行了审查。从2004年开始提供VAD支持（柏林心脏Excor儿科公司）。竞争风险分析用于为四个结果（HTx，等待名单上的死亡，退市，改善）之一的生存率建模。三十六名患者在等待HTx时接受了机械支持（21例ECMO，12例VAD，三例）。 ECMO列出的中位年龄为1.2岁（出生16.6岁），VAD列出的中位年龄为11.3岁（0.3-14.6岁）。诊断为心肌病的ECMO为33％，VAD为93％。 HTx的平均时间为37天（1-930），对于ECMO为20天（1-85），对于VAD为39天（5-108）。机械支持与HTx几率增加有关（危险比[HR] 2.4 [1.7-3.3]，P <0.0001），但也有除名或等待死亡的情况（HR 3.0 [1.1-7.8]，P = 0.03）。使用VAD可使ECMO的候补死亡率降低38％，降至13％。在接受VAD支持的组中，HTx到医院出院后的存活率更高（92％对80％）。需要机械支持作为HTx桥梁的儿科患者等待时间短，但等待者死亡率高。那些幸存下来并根据个性化临床决策使用柏林心脏Excor儿科设备的患者的候诊死亡率更低，支持时间更长，并且移植和出院的存活率更高。

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