Early experience with the HeartMate 3 continuous-flow ventricular assist device in pediatric patients and patients with congenital heart disease: A multicenter registry analysis.,The Journal of Heart and Lung Transplantation

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Early experience with the HeartMate 3 continuous-flow ventricular assist device in pediatric patients and patients with congenital heart disease: A multicenter registry analysis.
The Journal of Heart and Lung Transplantation ( IF 8.9 ) Pub Date : 2020-02-13 , DOI: 10.1016/j.healun.2020.02.007
Matthew J O'Connor ₁ , Angela Lorts ₂ , Ryan R Davies ₃ , Francis Fynn-Thompson ₄ , Anna Joong ₅ , Katsuhide Maeda ₆ , Christopher E Mascio ₇ , Patrick I McConnell ₈ , Michael C Mongé ₉ , Deipanjan Nandi ₁₀ , David M Peng ₁₁ , David N Rosenthal ₁₂ , Ming-Sing Si ₁₃ , David L Sutcliffe ₁₄ , Christina J VanderPluym ₁₅ , Melita Viegas ₁₆ , Farhan Zafar ₂ , Matthew Zinn ₁₇ , David L S Morales ₂

Affiliation

Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio.
Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center and Children's Health, Dallas, Texas.
Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
Departments of Cardiothoracic Surgery and Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California.
Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio.
Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
Division of Cardiology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan.
Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California.
Department of Cardiac Surgery, Division of Pediatric Cardiovascular Surgery, University of Michigan, Ann Arbor, Michigan.
Department of Pediatrics, UT Southwestern Medical Center and Children's Medical Center, Dallas, Texas.
Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

BACKGROUND

The HeartMate 3 ventricular assist device (VAD) is a newer centrifugal continuous-flow VAD used for bridge-to-transplant and destination therapy in adults. However, there is limited experience regarding its use in children and adults with complex congenital heart disease (CHD).

METHODS

The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) is a multicenter learning network comprised of pediatric hospitals implanting VADs in children and adults with complex CHD. We examined the outcomes of patients undergoing HeartMate 3 implantation at an ACTION center between December 2017 and September 2019.

RESULTS

The HeartMate 3 was implanted in 35 patients at 9 ACTION centers, with a median age of 15.7 (8.8–47.3) years, median weight of 65.7 (19.1–114.1) kg, and median body surface area (BSA) of 1.74 (0.78–2.36) m². Of the cohort, 14 patients (40%) weighed <60 kg. Diagnoses included dilated cardiomyopathy (63%), dilated cardiomyopathy in neuromuscular disease (20%), and CHD (17%). Of those with CHD, most had a Fontan circulation. With a median 78 days of follow-up, there was 1 death on device (97% survival); 20 out of 35 (57%) underwent transplantation with no post-transplantation mortality. There were no episodes of stroke or pump thrombosis.

CONCLUSIONS

Use of the HeartMate 3 in ACTION centers was associated with a low incidence of mortality and adverse events. Patients as small as 19 kg (BSA 0.78 m²) were successfully implanted and supported, indicating that this device may be appropriate for older children and small adults.

中文翻译：

小儿患者和先天性心脏病患者使用HeartMate 3连续流心室辅助设备的早期经验：多中心注册表分析。

背景

HeartMate 3心室辅助设备（VAD）是一种较新的离心式连续流VAD，用于成人的桥接移植和目的地治疗。但是，关于其在患有复杂先天性心脏病（CHD）的儿童和成人中使用的经验有限。

方法

先进的心脏治疗改善结局网络（ACTION）是一个多中心学习网络，由在复杂CHD的儿童和成人中植入VAD的儿科医院组成。我们在2017年12月至2019年9月期间在ACTION中心检查了接受HeartMate 3植入的患者的结局。

结果

HeartMate 3植入了9个ACTION中心的35例患者，中位年龄为15.7（8.8-47.3）岁，中位体重为65.7（19.1-114.1）kg，中位表面积（BSA）为1.74（0.78- 2.36）m ²。在该队列中，有14名患者（40％）体重<60 kg。诊断包括扩张型心肌病（63％），神经肌肉疾病的扩张型心肌病（20％）和冠心病（17％）。在患有冠心病的患者中，大多数患有Fontan循环。平均随访78天，装置死亡1例（存活率97％）；35名患者中有20名（57％）进行了移植，无移植后死亡率。没有中风或泵血栓形成的发作。