[Left ventricular assistance by postoperative mechanical devices in neonates].
Circulatory assistance in children and neonates has not been extensively reported. It poses specific problems related mainly to miniaturisation of systems. The authors report three cases of left ventricular assistance with the Biomedicus centrifugal pump followed by functional recovery in neonates operated for d-transposition of the great arteries. The assistance was installed by cannulation of the left atrial appendage and the ascending aorta, the canules being connected to the Biomedicus pump. The duration of assistance was 53, 116 and 120 hours respectively. The beginning of left ventricular recovery was observed after 24, 48 and 70 hours of assistance and the patients were weaned of assistance under stable haemodynamic conditions. One of the major problems during the period of assistance is decoagulation, 2 out of 3 patients requiring removal of thrombi during the first 12 hours of assistance. On the other hand, no cases of systemic embolism or thrombosis in the pump itself were observed. Decoagulation was maintained by continuous intravenous heparin with an initial dosage of 5 U/kg/h adapted to the activated cephalin time and anti Xa levels measured every 6 hours. No infectious complication was observed and the sternal wound healed satisfactorily despite systematic delayed closure of the thorax. The quality of results requires cooperation of a surgical infrastructure used to techniques of circulatory assistance, a well equipped neonatal intensive care unit and a permanently accessible laboratory for monitoring coagulation status.
Robin
J
J
Service de chirurgie thoracique et cardiovasculaire, Hôpital cardiologique, Lyon.
Tronc
F
F
Curtil
A
A
Sassolas
F
F
Vedrinne
C
C
Ninet
J
J
Champsaur
G
G
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005112:Extracorporeal Circulation; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D011184:Postoperative Period; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy
D006493:Heparin