초록접수 현황
| 16F-227 | 구연 발표 |
EXCOR Pediatric - Challenges and Opportunities in Pediatric VAD Therapy
Hsiao-Huang Chang
Taipei Veterans General Hospital, Taiwan
Background : Due to the shortage of donor organs and prolonged waiting times to heart transplantation (HTX), the usage of long-term ventricular assist devices (VADs) has recently substantially grown even in the field of pediatric cardiac therapy. Among the existing VADs, EXCOR Pediatric is the only systemapproved for pediatric patients. It allows short- to long-term as well as uni- and biventricular support for pediatric patients from newborn to adolescents.
Methods : A review ofthe relevant literature was made to define optimal treatment for pediatric patients awaiting HTX
Results : To achieve optimal outcome, timing of the VAD implantation is crucial. The moment of implantation has to be carefully balanced between the wish of having as less intervention as possible and the necessity to avoid end organ damage and other complications due to low-flow state (Miller, 2015).Also the decisionhas to be madewhether left ventricular support alone is sufficient or biventricular support is necessary.Most children can be treated with left ventricular assist devices (LVAD)alone, however 25 - 45% need primarybiventricular support (Sandica, 2016; Cassidy, 2013). The latter was identified as a predictor for higher mortalityreflecting themore profound patient sickness. However with careful early identification of patients in need of biventricular support, even in this patient cohort survival to HTXrates of 87% can be achieved (Miller, 2015).
Conclusion : Conclusion:High rates of survival to HTX are achievable, if patients are thoroughly treated: Regular pump inspection, optimal anticoagulation and meticulous wound-care are important factors to minimize the risk for complications such as bleeding, thromboembolism and infection. Protocols and standardization of care by qualified specialists and the introduction of dedicated interdisciplinary VAD teamshelped to improve results over the last years.In additionrehabilitation, psychosocial support and education must be provided for children on VADs to thrive and prepare them for HTX.
Methods : A review ofthe relevant literature was made to define optimal treatment for pediatric patients awaiting HTX
Results : To achieve optimal outcome, timing of the VAD implantation is crucial. The moment of implantation has to be carefully balanced between the wish of having as less intervention as possible and the necessity to avoid end organ damage and other complications due to low-flow state (Miller, 2015).Also the decisionhas to be madewhether left ventricular support alone is sufficient or biventricular support is necessary.Most children can be treated with left ventricular assist devices (LVAD)alone, however 25 - 45% need primarybiventricular support (Sandica, 2016; Cassidy, 2013). The latter was identified as a predictor for higher mortalityreflecting themore profound patient sickness. However with careful early identification of patients in need of biventricular support, even in this patient cohort survival to HTXrates of 87% can be achieved (Miller, 2015).
Conclusion : Conclusion:High rates of survival to HTX are achievable, if patients are thoroughly treated: Regular pump inspection, optimal anticoagulation and meticulous wound-care are important factors to minimize the risk for complications such as bleeding, thromboembolism and infection. Protocols and standardization of care by qualified specialists and the introduction of dedicated interdisciplinary VAD teamshelped to improve results over the last years.In additionrehabilitation, psychosocial support and education must be provided for children on VADs to thrive and prepare them for HTX.
책임저자: Hsiao-Huang Chang
Taipei Veterans General Hospital, Taiwan
발표자: Hsiao-Huang Chang, E-mail : do154@yahoo.com.tw