title: Improved early outcome for end-stage dilated cardiomyopathy in children.
abstract: 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.
authors.affiliation: Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: McMahon
authors.forename: Carin
authors.initials: C
authors.lastname: van Doorn
authors.forename: Michael
authors.initials: M
authors.lastname: Burch
authors.forename: Pauline
authors.initials: P
authors.lastname: Whitmore
authors.forename: Sophie
authors.initials: S
authors.lastname: Neligan
authors.forename: Philip
authors.initials: P
authors.lastname: Rees
authors.forename: Rosemary
authors.initials: R
authors.lastname: Radley-Smith
authors.forename: Allan
authors.initials: A
authors.lastname: Goldman
authors.forename: Katherine
authors.initials: K
authors.lastname: Brown
authors.forename: Gordon
authors.initials: G
authors.lastname: Cohen
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
authors.forename: Martin
authors.initials: M
authors.lastname: Elliott
authors.forename: Marc R
authors.initials: MR
authors.lastname: de Leval
mesh_terms: 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