Results of pediatric mechanical assist for postcardiotomy ventricular failure and cardiac arrest

Amac: Bu calismada postkardiyotomi ventrikuler yetmezlik ve kardiyak arrest icin yogun bakim unitesinde pediyatrik mekanik destek cihaz kullaniminin sonuclari degerlendirildi. Ca­lis­ma­pla­ni:­Şubat 2000 Şubat 2012 tarihleri arasinda klinigimizde 1800 pediatrik kalp ameliyati yapildi. Bu hastalardan 10’unda (5 erkek, 5 kiz; medyan yas 3 ay; dagilim 2.5 ay ile 4.5 yil) postkardiyotomi kalp yetmezligi ve kardiyopulmoner yetersizlik icin yogun bakim unitesinde pediatrik mekanik destek cihazlari gerekli oldu. Dort hastada sol atriyal apendiks ve cikan aort kanulasyonu ile roller pompa destegi gecici sol ventrikul destegi icin kullanildi. Alti hastada ise, ekstrakorporeal membran oksijenasyonu (ECMO) gecici kardiyak ve pulmoner destek icin kullanildi. Bul gu lar: Roller pompa destek grubunda uc hasta (%75), ECMO destek grubunda uc hasta (%50) basarili bir sekilde mekanik destekten ayrilabildi. En uzun mekanik destek, arteriyel switch ameliyati sonrasi yedi aylik bebekte sol ventrikul yetmezligi nedeniyle 160 saat sure ile roller pompa destegi ile yapildi. Roller pompa destegi grubundaki iki hastadan biri (4 yas) arteriyel switch ameliyati sonrasi, digeri (2.5 ay) pulmoner arterden cikan anormal sol koroner arter anomalisi nedeniyle yapilan ameliyat sonrasi, sol ventrikul disfonksiyonu nedeniyle mekanik destege gereksinim duydu. Her iki hasta da 48 saat sonra roller pompa desteginden basarili sekilde ayrildi. Iki hastada ventrikuler septal defekt kapatilmasi sonrasinda yogun bakim unitesinde pulmoner hipertansif kriz nedeniyle kardiyak arrest gelisti ve ECMO destegi gerekli oldu ve ECMO destegi 12 ve 48 saat sonra basarili bir sekilde sonlandirildi. So­nuc:­ Pediyatrik mekanik dolasim destegi, kardiyak cerrahi sonrasi kardiyopulmoner yetmezlik gelisen ve konvansiyonel resusitatif cabalara yanit vermeyen hastalar icin hayat kurtarici bir islemdir. Geleneksel roller pompa destegi, secilmis olgularda gecici sol ventrikul disfonksiyonu icin alternatif bir yontemdir. Anah tar soz cuk ler: Centrifugal pump; extracorporeal membrane oxygenator; roller pump; ventrikuler destek cihazi. Background:­ This study aims to evaluate the results of pediatric mechanical assist device use for postcardiotomy ventricular failure and cardiac arrest in the intensive care unit. Methods: Between February 2000 and February 2012, 1800 patients underwent pediatric cardiac operation in our department. Among these patients 10 (5 boys, 5 girls; median age 3 months; range 2.5 month to 4.5 years) needed mechanical assist devices for postcardiotomy cardiac failure and cardiopulmonary failure in the intensive care unit. In four patients, roller pump support with left atrial appendage and ascending aorta cannulation was used for temporary left ventricle support. In six patients, extracorporeal membrane oxygenation (ECMO) was used for temporary cardiac and pulmonary support. Results:­Three patients in the roller pump support group (75%) and three patients in the ECMO support group (50%) were successfully weaned from the mechanical assist. The longest mechanical support with the roller pump for left ventricle dysfunction was 160 hours in a seven-month-old infant after arterial switch operation. Mechanical support was required in two patients in the roller support group including one (4 years old) after arterial switch operation and one (2.5 months old) due to the left ventricular dysfunction after surgery for anomalous left coronary artery from pulmonary artery. Both patients were successfully weaned from the roller pump support after 48 hours. In two patients ECMO support was necessary for cardiac arrest due to pulmonary hypertensive crisis in the intensive care unit following the ventricular septal defect closure and ECMO was successfully weaned off after 12 and 48 hours. Conclusion:­ Pediatric mechanical circulatory support is a life-saving procedure for patients who develop cardiopulmonary failure after cardiac surgery and are unresponsive to the conventional resuscitative efforts. Conventional roller pump support is an alternative method for temporary left ventricle dysfunction in selected cases.