[Mechanical circulatory support after paediatric cardiac surgery].
When circulatory failure occurs after paediatric cardiac surgery despite conventional therapy (inotropic medication, optimising pre- and afterload) mechanical assist devices can be used. Assist devices can be categorised in different ways: according to the type of pump used (centrifugal, axial flow, or pneumatic), according to univentricular or biventricular support and in relation to the presence of an oxygenator. Paediatric devices are non-implantable. Extra-corporeal membrane oxygenation (ECMO) consists of a roller pump and a membrane oxygenator and is a relatively simple means of biventricular cardiac support while respiratory support is provided at the same time. All other devices lack the oxygenator and thus provide only circulatory support. The main disadvantage of ECMO is that it can be used for a maximum of several weeks while modern pneumatic assist devices (MEDOS, Berlin Heart) can be used for several months. Thromboembolic events, bleeding and sepsis are the main complications of all assist devices. The use of circulatory assist devices can increase the chances of survival when severe cardio(pulmonary) failure occurs following surgical correction of congenital heart defects.
Leids Universitair Medisch Centrum, Kinderhartcentrum D6-26, afd Cardiothoracale Chirurgie, Leiden. m.g.hazekamp@lumc.nl
M G
MG
Hazekamp
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D011183:Postoperative Complications; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome