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Ann Thorac Surg 1999;68:2320-2323
© 1999 The Society of Thoracic Surgeons

Original Articles

Minimally invasive mechanical cardiac support without extracorporeal membrane oxygenation in children awaiting heart transplantation

Daniel Marelli, MDa, Hillel Laks, MDa, Deborah A. Meehan, MSNa, Daniel Fazio, BSa, Juan Alejos, MDa

a Division of Cardiothoracic Surgery, University of California, Los Angeles Medical Center, Los Angeles, California, USA

Address reprint requests to Dr Marelli, Division of Cardiothoracic Surgery, UCLA School of Medicine, 10833 Le Conte Ave, Box 951741, Los Angeles, CA 90095-1741
e-mail: dmarelli{at}surgery.medsch.ucla.edu

Background. Mechanical cardiac assist for small children (< 30 kg) requiring bridge strategy to orthotopic heart transplantation often requires sternotomy for cannulation access to ensure perfusion to the aortic arch. Extracorporeal membrane oxygenation (ECMO) through neck cannulation is an option in very small (< 10 kg) patients, but the risk of stroke is increased in larger children. Another disadvantage is poor decompression of the left atrium, which can cause persistent pulmonary edema.

Methods. Two cases are used to illustrate two methods of avoiding sternotomy during mechanical assist in children with dilated cardiomyopathy. One of these approaches avoids the need for extracorporeal oxygenation.

Results. Decompression of the left-sided chambers with a left atrial cannula decreased pulmonary edema and improved pulmonary function.

Conclusions. Pediatric patients with dilated cardiomyopathy may benefit from a left ventricular assist technique using a centrifugal pump, which avoids the neck vessels and sternotomy, as well as ECMO.






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Copyright © 1999 by The Society of Thoracic Surgeons.