Corheart 6左心室辅助装置治疗儿童心肌病晚期心力衰竭

Efficacy of Corheart 6 ventricular assist device for advanced heart failure in children with cardiomyopathy

目的总结心室辅助装置治疗儿童心肌病晚期心力衰竭初步临床管理经验。方法收集2023年2月至2024年2月在浙江大学医学院附属儿童医院行植入Corheart 6左心室辅助装置+三尖瓣环缩术的3例心肌病晚期心力衰竭患儿的临床资料,其中男1例,女2例;年龄12~14岁;体重30.0~38.0 kg。患儿心功能按照纽约心脏协会分级(New York Heart Association,NYHA)标准以及机械辅助循环支持机构间登记(Interagency Registry for Mechanically Assisted Circulatory Support,INTERMACS)标准进行分级;依照美国心脏病学院分期(American College of Cardiology,ACC)标准分期,术后出院随访,生活质量采用堪萨斯城心肌病问卷(Kansas city cardiomyopathy questionnaire,KCCQ)进行评分。结果例1为心内膜弹力纤维增生症+左心室部分心肌致密化不全,心功能NYHA Ⅳ级,INTERMACS Ⅲ级,ACC分期为D期;例2和例3为扩张型心肌病,心功能NYHAⅣ级,INTERMACS分别为Ⅲ级和Ⅱ级,ACC分期均为D期。3例患儿均顺利完成手术并出院,术后随访4个月至1年,体能明显增加,未发生重大并发症。KCCQ评分由术前6.5~35分提高到88~92分。3例患儿均未发生伤口感染,其中2例术后半年左右复学,1例在家休养。结论植入式左心室辅助装置应用于心肌病晚期心力衰竭患儿,可明显改善生存质量。

Objective To summarize the preliminary clinical experiences of managing advanced heart failure with ventricular assist devices in cardiomyopathy children.Methods From February 2023 to February 2024,the relevant clinical data were retrospectively reviewed for 3 cardiomyopathy children with advanced heart failure undergoing Corheart 6 left ventricular assist device plus tricuspid valvuloplasty.There were 1 boy and 2 girls with an age range of(12-14)years and a body weight of(30.0-38.0)kg.According to the standards of New York Heart Association(NYHA),Interagency Registry for Mechanically Assisted Circulatory Support(INTERMACS)and American College of Cardiology(ACC),heart functions were staged.And Kansas City Cardiomyopathy Questionnaire(KCCQ)score was assessed during postoperative follow-ups.Results Case 1 had endocardial elastic fibroplasia plus partial left ventricular myocardial densification insufficiency,NYHA grade Ⅳ,INTERMACS grade Ⅲ and ACC stage D;Cases 2 and 3 suffered from dilated cardiomyopathy with NYHA grade IV,INTERMACS grade Ⅲ/Ⅱ and ACC stage D.After discharge,they were followed up for 4 months to 1 year post-operation.Physical strength gained significantly and no major complications occurred.KCCQ score was significantly higher at post-operation than that at pre-operation[(88-92)vs(6.5-35)].There was no onset of wound infection.Two children returned to school at 6 months postoperatively while another child recuperated at home.Conclusions Implantable left ventricular assist devices can significantly boost the quality-of-life in cardiomyopathy children with advanced heart failure.