PEDIATRIC PATIENTS WITH IMPLANTED LEFT VENTRICULAR ASSIST DEVICES END EXPIRIENSE OF PERSONALIZATION OF TREATMENT IN EARLY POSTOPERATIVE PERIOD
DOI:
https://doi.org/10.31379/2411.2616.14.2.5Keywords:
mechanical circulatory support, continuous flow left ventricle assist device, congestive heart failure in children.Abstract
For adult patients, devices of a continuous flow of mechanical support of blood circulation completely prevail over pulse ones, which is more than 90%. With the constant miniaturization of devices among pediatric cardiologists, the number of proposals for the use of continuous-flow VAD in children is growing. According to the first PediMACS report, approximately half (54%; 109 out of 200) of registered long-term devices are continuous-flow devices. This article describes the current state of the children’s system of a continuous flow of mechanical support for blood circulation and evaluates the prospects for its future direction. The experience and strategy of the Silesian Center for Heart Diseases in the early postoperative period was very similar to that used in patients after Fontaine’s operation, including special tactics of respiratory support, adding nitric oxide or leaving the chest open after the start of circulation support. Despite aggressive medical support, a certain part of the patients had right ventricular, which required temporary mechanical support to restore blood flow in the pulmonary circulation and increase LV preload. Early biventricular VAD correlates with better survival compared to a delay in its use. Thus, a thorough preoperative risk assessment of right ventricular failure is required for implantation of a biventricular VAD or for heart transplantation.
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