Coheart 6左心室辅助装置在儿童复杂先天性心脏病晚期心力衰竭中的应用

Application of Coheart 6 left ventricular assist device for advanced heart failure in children with complex congenital heart disease

目的总结应用左心室辅助装置(left ventricular assistant device,LVAD)治疗儿童复杂先天性心脏病晚期心力衰竭的临床特点、管理方式及预后情况。方法回顾性分析2022年1月至2023年12月中国医学科学院阜外医院收治的复杂先天性心脏病合并晚期左心衰行心脏畸形矫治术+LVAD植入2例患儿围手术期的临床资料。2例均为14岁男患儿,例1为40 kg,左心室流出道严重狭窄合并晚期左心衰,行Konno手术+LVAD植入术,维持LVAD转速2200~2400转/min,流量2.2~2.4 L/min;例2为43 kg,主动脉瓣大量反流合并晚期左心衰,行主动脉瓣生物瓣置换术+LVAD植入术,维持LVAD转速2000~2200转/min,流量2.0~2.4 L/min。在PubMed、Web of Science、Medline、中国知网和万方数据库中利用“儿童(children)”、“左心室辅助装置(LVAD)”、“体内(intracorporeal)”和“先天性心脏病(congenital heart disease)”为关键词进行文献检索2023年10月之前发表的相关文献并进行文献复习。结果例1术后3个月左心室射血分数由术前19%恢复至60%,顺利撤除LVAD,术后1年随访左心室大小及功能完全恢复正常。例2术后2个月左心室射血分数由术前16%上升至30%,目前已带泵出院。检索到国外相关文献7篇,出血、感染和右心衰竭是最主要的不良事件。结论儿童复杂先天性心脏病术后合并晚期左心衰患儿,在完成心脏畸形矫治同时植入LVAD可有效促进衰竭的左心室实现逆重构。

Objective To summarize the early clinical characteristics,managements and outcomes of left ventricular assist device(LVAD)for advanced left heart failure in children with complex congenital heart diseases.Methods Retrospective analysis was conducted for perioperative data of two patients with complex congenital heart diseases and advanced left heart failure undergoing cardiac malformation correction and LVAD implantation from January 2022 to December 2023.Both patients were 14-year-old boys.Case 1(40 kg)with severe left ventricular outflow tract stenosis and advanced left heart failure underwent Konno procedure and LVAD implantation.LVAD rotation was maintained at 2200-2400 r/min with a flow rate of 2.2-2.4 L/min.Case 2(43 kg)with massive aortic regurgitation complicated with advanced left heart failure underwent aortic biologic valve replacement plus LVAD implantation.LVAD speed was maintained at 2000-2200 r/min with a flow rate of 2.0-2.4 L/min.A literature review was conducted in the databases of PubMed,Web of Science,MEDLINE,China National Knowledge Infrastructure(CNKI)and Wanfang using the key words of"children","left ventricular assist device(LVAD)","intracorporeal"and"congenital heart disease"prior to October 2023.Results In case 1,left ventricular ejection fraction(LVEF)recovered from 19% to 60% at Month 3 post-operation.Then LVAD was removed successfully.Size and function of left ventricle completely normalized at 1 year.Case 2 with massive aortic regurgitation complicated with advanced left heart failure underwent aortic biologic valve replacement plus LVAD implantation.LVEF spiked from 16% to 30% at 2 months postoperatively and was discharged with pump.Seven foreign related articles were retrieved.The results showed that hemorrhage,infection and right heart failure were the major adverse events.Conclusion For children with advanced left heart failure after complex congenital heart disease surgery,LVAD implantation can effectively promote the reverse remodeling of failing left ventricle.