title: Mechanical circulatory support after paediatric heart transplantation.
abstract: OBJECTIVE
  Mechanical circulatory support (MCS) may be required after orthotopic heart transplantation (OHTx) in children for the treatment of failure or rejection. We review the incidence and outcomes of post-transplant MCS in our institution.
  
  
  METHODS
  MCS was classified as early (<1 month since transplant) or late (>1 month since transplant) and the support offered was either veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) or a ventricular assist device (VAD). From 2003 to the present, 100 children (<16 years) underwent OHTx. Fifteen (15%) had 17 episodes of MCS. MCS was instituted early in 10 and late in seven episodes. Two children required two episodes of support. VA-ECMO was used in 12 episodes (71%). Two children required VAD support alone (12%). In three (17%) episodes ECMO was subsequently converted from VAD.
  
  
  RESULTS
  Among 10 children with early failure, eight were successfully weaned from support with recovery of graft function. In the late failure group, three of six patients died. All but four patients underwent re-transplantation with no perioperative deaths. Overall survival to discharge was 66%. The early failure group shows a better survival rate to hospital discharge compared with the late failure group (78 vs 50%; P < 0.0001).
  
  
  CONCLUSIONS
  The incidence of post-transplant MCS for graft failure in our patients was 15%. Early graft failure has a better outcome than late failure. Re-transplantation has good mid-term outcomes in children. A stepwise approach with a multimodality MCS strategy improves survival in this group of patients.
authors.affiliation: Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK. giangio81@hotmail.com
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Perri
authors.forename: Asif
authors.initials: A
authors.lastname: Hasan
authors.forename: Jane
authors.initials: J
authors.lastname: Cassidy
authors.forename: Richard
authors.initials: R
authors.lastname: Kirk
authors.forename: Simon
authors.initials: S
authors.lastname: Haynes
authors.forename: John
authors.initials: J
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Crossland
authors.forename: Massimo
authors.initials: M
authors.lastname: Griselli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D055031:Primary Graft Dysfunction / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome