儿童晚期心力衰竭植入式左心室辅助装置手术技术

Surgical techniques of implantable left ventricular assist device for advanced heart failure in children

目的总结儿童植入式左心室辅助装置(left ventricular assist device,LVAD)的手术技术经验及效果。方法回顾分析2023年2月至2024年2月浙江大学医学院附属儿童医院收治的3例晚期心力衰竭患儿临床资料,其中男1例,女2例,年龄范围在12~14岁,体重30.0~38.0 kg。对LVAD植入手术的技术要点进行总结:连接LVAD泵,测试LVAD泵,制作线缆隧道,心内畸形修复,定位和缝合顶环,打孔刀取芯,泵头插入,人工血管吻合,启动血泵,血流动力学调整及止血关胸。结果3例患儿均在体外循环下顺利完成LVAD植入术+三尖瓣环缩术,术后第1天撤离呼吸机,直接口服华法林抗凝,术后7~9 d停用血管活性药物,并于术后30 d左右痊愈出院。出院随访LVAD运行良好,泵速分布为2400~2550转/min及流量为1.91~2.63 L/min,左右心功能匹配,室间隔居中略右。其中2例术后半年已重返校园,生活自理,1例在家休养。结论植入式LVAD是治疗儿童晚期心力衰竭安全有效的方法。不同于成人患者,在LVAD的选择及具体植入技术方面需要更多的考量。

Objective To summarize the surgical experiences of implantable left ventricular assist devices(LVAD)in children.Methods The relevant clinical data were retrospectively reviewed for 3 children with advanced heart failure undergoing LVAD implantation plus tricuspid valve ring retraction.Surgical techniques were discussed.Results Three kids with dilated cardiomyopathy underwent LVAD implantation plus tricuspid valvoplasty under cardiopulmonary bypass(CPB).Warfarin anticoagulation was initiated without heparin bridge early after ventilator weaning.Intravenous inotropic support was discontinued at Day 7-9 after CPB.Discharge occurred at Day 30 after CPB.During follow-ups,LVAD worked well with a pump speed of(2400-2550)rpm and a flow rate of(1.91-2.63)L/min.Left and right ventricular functions were matched well and ventricular septum was centered slightly to right.The first two cases returned to school and resumed living independently.Conclusion Implantable LVAD is both safe and effective for advanced heart failure in children.Different from adult patients,more considerations are required for proper selections of VAD and specific implant techniques.