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J Thorac Cardiovasc Surg 1999;117:529-542
© 1999 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
From the Departments of Cardiac Surgery,a Cardiology,b and Surgery,c Children's Hospital, Boston, Mass.
Received for publication Dec 29, 1997. Revisions requested April 9, 1998; revisions received June 8, 1998. Accepted for publication Oct 7, 1998. Address for reprints: Jay M. Wilson, MD, Department of Surgery, Children's Hospital, 300 Longwood Ave, Boston, MA 02115.
Objective: To review the experience from a single center that uses both extracorporeal membrane oxygenation and ventricular assist devices for children with cardiac disease requiring mechanical circulatory support.
Methods: A retrospective chart review was performed for all pediatric patients with cardiac disease who required support with extracorporeal membrane oxygenation or ventricular assist devices. Statistical analysis of the impact of multiple clinical parameters on survival was performed.
Results: From 1987 through 1996 we provided mechanical circulatory support for children with a primary cardiac diagnosis using extracorporeal membrane oxygenation (67 patients) and ventricular assist devices (29 patients). Twenty-seven of 67 (40.3%) patients supported with extracorporeal membrane oxygenation and 12 of 29 (41.4%) patients supported with ventricular assist devices survived to hospital discharge. Failure of return of ventricular function within 72 hours of the institution of support was an ominous sign in patients supported with either modality. Univariate analysis revealed the serum pH at 24 hours of support, the serum bicarbonate at 24 hours of support, the urine output over the first 24 hours of support, and the development of renal failure to have a statistically significant association with survival in children supported with extracorporeal membrane oxygenation. None of the clinical parameters evaluated by univariate analysis were significantly associated with survival in the patients supported with ventricular assist devices.
Conclusions: Extracorporeal membrane oxygenation and ventricular assist devices represent complementary modalities of mechanical circulatory support that can both be used effectively in children with cardiac disease.
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