Ersin EREK, Ahmet ARNAZ, Murat BOZ, Yasemin TÜRKEKUL, Ayşe ULUKOL, Bilge NARİN, Zekeriya TELLİ, Tayyar SARIOĞLU, Ayşe SARIOĞLU, Arda SAYGILI, Yusuf Kenan YALÇINBAŞ

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

Amaç: Bu çalışmada postkardiyotomi ventriküler yetmezlik ve kardiyak arrest için yoğun bakım ünitesinde pediyatrik mekanik destek cihaz kullanımının sonuçları değerlendirildi.Çalışmaplanı:Şubat 2000 - Şubat 2012 tarihleri arasında kliniğimizde 1800 pediatrik kalp ameliyatı yapıldı. Bu hastalardan 10'unda (5 erkek, 5 kız; medyan yaş 3 ay; dağılım 2.5 ay ile 4.5 yıl) postkardiyotomi kalp yetmezliği ve kardiyopulmoner yetersizlik için yoğun bakım ünitesinde pediatrik mekanik destek cihazları gerekli oldu. Dört hastada sol atriyal apendiks ve çıkan aort kanülasyonu ile roller pompa desteği geçici sol ventrikül desteği için kullanıldı. Altı hastada ise, ekstrakorporeal membran oksijenasyonu (ECMO) geçici kardiyak ve pulmoner destek için kullanıldı.Bul gu lar: Roller pompa destek grubunda üç hasta (%75), ECMO destek grubunda üç hasta (%50) başarılı bir şekilde mekanik destekten ayrılabildi. En uzun mekanik destek, arteriyel switch ameliyatı sonrası yedi aylık bebekte sol ventrikül yetmezliği nedeniyle 160 saat süre ile roller pompa desteği ile yapıldı. Roller pompa desteği grubundaki iki hastadan biri (4 yaş) arteriyel switch ameliyatı sonrası, diğeri (2.5 ay) pulmoner arterden çıkan anormal sol koroner arter anomalisi nedeniyle yapılan ameliyat sonrası, sol ventrikül disfonksiyonu nedeniyle mekanik desteğe gereksinim duydu. Her iki hasta da 48 saat sonra roller pompa desteğinden başarılı şekilde ayrıldı. İki hastada ventriküler septal defekt kapatılması sonrasında yoğun bakım ünitesinde pulmoner hipertansif kriz nedeniyle kardiyak arrest gelişti ve ECMO desteği gerekli oldu ve ECMO desteği 12 ve 48 saat sonra başarılı bir şekilde sonlandırıldı.So nuç: Pediyatrik mekanik dolaşım desteği, kardiyak cerrahi sonrası kardiyopulmoner yetmezlik gelişen ve konvansiyonel resüsitatif çabalara yanıt vermeyen hastalar için hayat kurtarıcı bir işlemdir. Geleneksel roller pompa desteği, seçilmiş olgularda geçici sol ventrikül disfonksiyonu için alternatif bir yöntemdir

Postkardiyotomi ventriküler yetmezlik ve kardiyak arrest için pediyatrik mekanik destek sonuçları

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

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