Extracorporeal circulatory support in pediatric cardiac patients — The Berlin Experience

  • V. Alexi-Meskishvili
  • R. Hetzer
  • Y. Weng
  • K. Ishino
  • E. Potapov
  • M. Loebe
  • E. Hennig
  • F. Uhlemann
  • P. E. Lange
Conference paper

Abstract

The institution of extracorporeal circulatory support in the pediatric population has been limited due to the scarcity of suitable devices. Although the successful use of miniaturized intra-aortic balloon pumps in children has been reported occasionally (23, 34), providing intra-aortic balloon pump support in this cohort has been hampered by difficulties associated with inserting cannulas into small vessels and synchronizing the device to a rapid heart rate. Its efficacy has further been questioned in small children because of increased aortic compliance. Over the last decade circulatory support in pediatric surgery has most commonly been provided through extracorporeal membrane oxygenation (ECMO)(14, 17, 25, 36). The capability of ECMO to provide biventricular as well as respiratory support may be beneficial in maintaining circulation in children, especially those with congenital heart defects. Some recent reports have described the successful use of a centrifugal ventricular assist device (VAD) in children for cardiogenic shock after cardiac surgery (6, 15), for donor heart failure, and as a bridge to cardiac transplantation (26). However, the impossibility of mobilizing the patient, generating a pulseless flow, and the short durability of the components are critical disadvantages for long-term support with ECMO or centrifugal VADs.

Keywords

Left Ventricular Assist Device Extracorporeal Membrane Oxygenation Circulatory Support Ventricular Assist Device Mechanical Circulatory Support 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Dalton H, Siewers R, Fuhrman B, del Nido P, Tompson A, Shaver M, Dowhy M (1993) Extracorporeal membrane oxygenation for cardiac rescue in children with severe myocardial dysfunction. Crit Care Medicine Vol. 21 No 7:1020–1028CrossRefGoogle Scholar
  2. 2.
    del Nido PJ, Dalton HJ, Thompson AE, Siewers RD (1992) Extracorporeal membrane oxygenation rescue in children during cardiac arrest after cardiac surgery. Circulation 86 suppl II:300–304Google Scholar
  3. 3.
    del Nido PJ, Armitage JM, Fricker FJ, Shaver M, Cipriani L, Dayal G, Park SC, Siewers RD (1994) Extracorporeal membrane oxygenation support as a bridge to pediatric heart transplantation. Circulation 90[part 2]: II-66–69Google Scholar
  4. 4.
    Delius R, Bove E, Meliones J, Custer J, Moler F, Crowly D, Amirikia A, Behrendt D, Bartlett R (1992) Use of extracorporeal life support in patients with congenital heart disease. Crit Care Med 20:1216–1222PubMedCrossRefGoogle Scholar
  5. 5.
    Farrar DJ, Hill JD (1994) Recovery of major organ function in patients awaiting heart transplantation with Thoratec Ventricular Assist Device. J Heart Lung Transplant 13:1125–1132PubMedGoogle Scholar
  6. 6.
    Ferrazzi P, Glauber M, Di Domenico A, Fiocchi R, Mamprin F, Gamba A, Crupi G, Cossolini M, Parenzan L (1991) Assisted circulation for myocardial recovery after repair of congenital heart disease. Eur J Cardio-thorac Surg 5:419–424CrossRefGoogle Scholar
  7. 7.
    Frazier OH, Bricker JT, Macris MP, Cooley DA (1989) Use of a left ventricular assist device as a bridge to transplantation in a pediatric patient. Tex Heart Inst J 16:46–50PubMedGoogle Scholar
  8. 8.
    Friedel N, Viazis P, Schiessler A, Warnecke H, Hennig E, Trittin A, Böttner W, Hetzer R (1992) Recovery of end-organ failure during mechanical circulatory support. Eur J Cardiothorac Surg 6: 519–523PubMedCrossRefGoogle Scholar
  9. 9.
    Galantowicz ME, Stolar CJH (1991) Extracorporeal membrane oxygenation for perioperative support in pediatric heart transplantation. J Thorac Cardiovasc Surg 102: 148–152PubMedGoogle Scholar
  10. 10.
    Heiss KF, Petit B, Hirschl RB, Cilley RC, Chapman R, Barlett RH (1987) Renal Insufficiency and volume overload in neonatal ECMO managed by continuous ultrafiltration. Trans Am Soc Artif Intern Organs 23:557–560Google Scholar
  11. 11.
    Heney D, Brocklebank JT, Wilson N (1989) Continuous arteriovenous haemofiltration in the newlyborn with acute renal failure and congenital heart disease. Nephrol Dial Transplant 4:870–876PubMedGoogle Scholar
  12. 12.
    Hennig E, Bücherl ES (1989) The “Berlin artificial heart” system. In: D’Alessandro LC (ed) Heart Surgery, C.E.S.I., Rome, pp 167–179Google Scholar
  13. 13.
    Hunkeler N, Canter, Donze A, Sray T (1992) Extracorporeal life support in cyanotic congenital Heart Disease Before Cardiovascular Operation. Am J Cardiol 69:790–793PubMedCrossRefGoogle Scholar
  14. 14.
    Kanter KR, Pennington DG, Weber TR, Zambie MA, Braun P, Martychenko V (1987) Extracorporeal membrane oxygenation for postoperative cardiac support in children. J Thorac Cardiovasc Surg 93:27–35PubMedGoogle Scholar
  15. 15.
    Karl TR, Sano S, Horton S, Mee RBB (1991) Centrifugal pump left heart assist in pediatric cardiac operations. J Thorac Cardiovasc Surg 102:624–630PubMedGoogle Scholar
  16. 16.
    Karl TR (1994) Extracorporeal circulatory support in infants and children. Seminars in Thorac and Cardiovasc Surg 6:154–160Google Scholar
  17. 17.
    Klein MD, Shaheen KW, Whittlesy GC, Pinsky WW, Arciniegas E (1990) Extracorporeal membrane oxygenation for the circulatory support after repair of congenital heart disease. J Thorac Cardiovasc Surg 100:498–505PubMedGoogle Scholar
  18. 18.
    Klein MD, Withlesey GC (1994) Extracorporeal membrane oxygenation. Pediatric Clinics of North America. Vol. 41 No 2:365–384PubMedGoogle Scholar
  19. 19.
    Loebe M, Weng Y, Hennig E, Alexi-Meskishvili V, Uhlemann F, Schiessler A, Lange PE, Kopitz M, Hetzer R (1995) Mechanische Kreislaufunterstützung bei Kindern und Jugendlichen mit pulsatilem und non-pulsatilem Fluß. Z. Herz-, Thorax-, Gefäßchirur 9:85–93Google Scholar
  20. 20.
    Matsuda H, Taenaka Y, Obkubo N, Ohtani M, Nishigaki K, Ohtake S, Miura T, Taenaka N, Takano H, Hirose H, Kawashima Y (1988) Use of a paracorporeal pneumatic ventricular assist device for postoperative cardiogenic shock in two children with complex cardiac lesions. Artif Organs 12:423–430PubMedCrossRefGoogle Scholar
  21. 21.
    Pavie A, Muneretto C, Aupart M, Rabago G, Leger P, Tedy G, Bors V, Gandjbakhch I, Cabrol C (1991) Prognostic indices of survival in patients supported with temporary devices (TAH, VAD). International Journal of Artificial Organs 14(5): 280–285PubMedGoogle Scholar
  22. 22.
    Pennington DG, Kanter KR, McBride LR, Kaiser GC, Earner HE, Miller LW, Naunheim KS, Fiore AC, Willman V (1988) Seven years’ experience with the Pierce-Donachy ventricular assist device. J Thorac Cardiovasc Surg 96:901–911PubMedGoogle Scholar
  23. 23.
    Pollock JC, Charlton MC, Williams WG, Edmonds JF, Trusler GA (1980) Intraaortic balloon pumping in children. Ann Thorac Surg 29:522–528PubMedCrossRefGoogle Scholar
  24. 24.
    Robinson TM, Kickler TS, Walker LK, Ness P, Bell W (1993) Effect of extracorporeal membrane oxygenation on platelets in newborns. Crit Care Med 21:1029–1034PubMedCrossRefGoogle Scholar
  25. 25.
    Rogers AJ, Trento A, Siewers RD, Griffith BP, Hardesty RL, Pahl E, Beerman LB, Fricker FJ, Fischer DR (1989) Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock in children. Ann Thorac Surg 47:903–906PubMedCrossRefGoogle Scholar
  26. 26.
    Scheinin SA, Radovancevic B, Parnis SM, Ott DA, Ericker JT, Twobin JA, Abou-Awdi NL, Frazier OH (1994) Mechanical circulatory support in children. Eur J Cardio-thorac Surg 8:537–540CrossRefGoogle Scholar
  27. 27.
    Schiessler A, Friedel N, Weng Y, Heinz U, Hummel M, Hetzer R (1994) Mechanical circulatory support and heart transplantation. ASAIO J 40:M476-M481PubMedCrossRefGoogle Scholar
  28. 28.
    Schneider E, Cronin J, Van Marter L, Maller E, Truog R, Jacobson M, Kevy S (1991) A prospective analysis of cholestasis in infants supported with extracorporeal membrane oxygenation. Journal of Pediatric Gastroenterology & Nutrition 13(3):285–289CrossRefGoogle Scholar
  29. 29.
    Steinhorn R, Isham-Schopf B, Smith C, Green T (1989) Hemolysis during long-term extracorporeal membrane oxygenation. J Pediatr 115:625–630PubMedCrossRefGoogle Scholar
  30. 30.
    Stolar CJH, Delosh T, Bartlett RH (1993) Extracorporeal Life Support Organization Registry Report. ASAIO J 39:976–979PubMedGoogle Scholar
  31. 31.
    Suddaby E, O’Brien A (1993) ECMO in cardiac support in children. Heart Lung 22:401–407PubMedGoogle Scholar
  32. 32.
    Taenaka N, Takano H, Noda H, Kinoshita M, Tatsumi E, Yagura A, Sekii H, Sasaki E, Akutsu T (1989) Experimental evaluation and clinical application of a pediatric ventricular assist device. ASAIO Trans 35:606–608PubMedCrossRefGoogle Scholar
  33. 33.
    Ungerleider R (1994) Current application of neonatal ECMO. Presented at the 14th Annual San Diego Cardiothoracic surgery symposium. San Diego, USA. P. 119–130Google Scholar
  34. 34.
    Veasy LG, Blalock RC, Orth JL, Boucek MM (1983) Intra-aortic balloon pumping in infants and children. Circulation 68:1095–1100PubMedCrossRefGoogle Scholar
  35. 35.
    Warnecke H, Berdjis F, Hennig E, Lange P, Schmitt D, Hummel M, Hetzer R (1991) Mechanical left ventricular support as a bridge to cardiac transplantation in childhood. Eur J Cardiothorac Surg 5:330–333PubMedCrossRefGoogle Scholar
  36. 36.
    Weinhous L, Canter C, Noetzel M, McAlister W, Spray TL (1989) Extracorporeal membrane oxygenation for circulatory support after repair of congenital heart defects. Ann Thorac Surg 48:206–212CrossRefGoogle Scholar
  37. 37.
    Zwischenberger J, Cox C (1992) ECMO in the management of cardiac failure. ASAIO Journal 38:751–753PubMedGoogle Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt 1997

Authors and Affiliations

  • V. Alexi-Meskishvili
    • 1
  • R. Hetzer
    • 1
  • Y. Weng
    • 1
  • K. Ishino
    • 1
  • E. Potapov
    • 1
  • M. Loebe
    • 1
  • E. Hennig
    • 1
  • F. Uhlemann
    • 1
  • P. E. Lange
    • 1
  1. 1.Department of Cardiothoracic and Vascular SurgeryGerman Heart Institute BerlinBerlin-BuchGermany

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