Improved early outcome for end-stage dilated cardiomyopathy in children.
OBJECTIVE
To review the impact of management changes on the early outcomes of end-stage dilated cardiomyopathy in children.


METHODS
We conducted a retrospective study of all consecutive children with end-stage dilated cardiomyopathy who received hospital treatment since 1992. Over the past 3 years the following management changes were made: (1) more aggressive use of mechanical cardiac assistance; (2) high priority listing for transplantation; and (3) ABO incompatible transplants for infants. Outcomes for 46 patients admitted between 1992 and 1999 (group I) were compared with 53 patients between 2000 and March 2003 (group II).


RESULTS
In group I, 12 (26%) patients received mechanical support with recovery in 3 and transplantation in 5 (1 died). In group II, 19 (36%) patients received extracorporeal membrane oxygenation, with recovery in 5 and transplantation in 12 (all survived). The use of mechanical assistance was associated with high morbidity related to bleeding, end-organ failure, and long-term mechanical ventilation. Five patients in group II received ABO incompatible transplants and all survived. There have been no episodes of rejection or need for increased immunosuppressive therapy. Hospital mortality has been significantly reduced (group I, 37% vs group II, 11%; P <.05).


CONCLUSIONS
Recent refinements in the management of end-stage dilated cardiomyopathy in children have significantly reduced early mortality. Identification of markers of early myocardial recovery and development of mechanical devices for longer term and more physiologic support are essential to achieve further improvements in outcome.
McMahon
Anne-Marie
AM
Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom.
van Doorn
Carin
C
Burch
Michael
M
Whitmore
Pauline
P
Neligan
Sophie
S
Rees
Philip
P
Radley-Smith
Rosemary
R
Goldman
Allan
A
Brown
Katherine
K
Cohen
Gordon
G
Tsang
Victor
V
Elliott
Martin
M
de Leval
Marc R
MR
D000293:Adolescent; D001787:Blood Group Incompatibility; D002311:Cardiomyopathy, Dilated / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012121:Respiration, Artificial; D016896:Treatment Outcome