Dash F T Newington, Fabrizio De Rita, Alan McCheyne, Claire Louise Barker
{"title":"儿童心室辅助装置植入:麻醉视角。","authors":"Dash F T Newington, Fabrizio De Rita, Alan McCheyne, Claire Louise Barker","doi":"10.1177/1089253221998546","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures.</p><p><strong>Aims: </strong>To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease.</p><p><strong>Methods: </strong>Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019.</p><p><strong>Results: </strong>Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%).</p><p><strong>Conclusions: </strong>Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 3","pages":"229-238"},"PeriodicalIF":1.1000,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1089253221998546","citationCount":"2","resultStr":"{\"title\":\"Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective.\",\"authors\":\"Dash F T Newington, Fabrizio De Rita, Alan McCheyne, Claire Louise Barker\",\"doi\":\"10.1177/1089253221998546\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures.</p><p><strong>Aims: </strong>To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease.</p><p><strong>Methods: </strong>Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019.</p><p><strong>Results: </strong>Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%).</p><p><strong>Conclusions: </strong>Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.</p>\",\"PeriodicalId\":46500,\"journal\":{\"name\":\"Seminars in Cardiothoracic and Vascular Anesthesia\",\"volume\":\"25 3\",\"pages\":\"229-238\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2021-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1177/1089253221998546\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Seminars in Cardiothoracic and Vascular Anesthesia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/1089253221998546\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/3/16 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Seminars in Cardiothoracic and Vascular Anesthesia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/1089253221998546","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/3/16 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 2
摘要
背景:心室辅助装置(VADs)越来越多地被植入儿童,但很少有文献指导这些手术的麻醉管理。目的:描述以VAD植入术为临床表现的儿科患者以及这些患者接受的麻醉处理。比较(a) 12个月以下和12个月以上的儿童和(b)患有和不患有先天性心脏病的儿童。方法:回顾性分析2014年至2019年在单一中心接受VAD植入的0 ~ 17岁患者。结果:68例患者共植入77个VAD,其中左室VAD 46个,双室VAD 24个,右室VAD 6个,单室VAD 1个。一个程序被放弃了。术前20例(26%)患者采用体外膜氧合,57例(73%)患者采用通气。74例(95%)患者需要术中供血制品。66例(85%)植入后需要肌力支持,46例(100%)左侧VAD患者需要肌力支持。12个月以下的婴儿更有可能需要术前体外膜氧合(42%对19%),有股静脉通道(54%对28%),术中接受血管收缩剂(42%对24%),以及延迟胸骨闭合(63%对22%)。12个月以下的患者死亡率更高(25% vs 19%),先天性心脏病患者死亡率更高(25% vs 20%)。结论:接受VAD植入的儿童术前需要高水平的器官支持,术中需要大剂量的肌力支持和大容量输血。12个月以下的儿童和患有先天性心脏病的儿童对麻醉师来说尤其具有挑战性,总体结果也更差。
Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective.
Background: Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures.
Aims: To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease.
Methods: Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019.
Results: Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%).
Conclusions: Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.