European Journal of Cardio-Thoracic Surgery, Vol 4, 649-652, Copyright © 1990 by European Association for Cardio-thoracic Surgery
Circulatory support in infants with post-cardiopulmonary bypass left ventricular dysfunction using a left ventricular assist device
NE Moat, A Pawade, BC Lewis, G Shore, RK Lamb and JJ Monro
Wessex Cardiothoracic Centre, Southampton General Hospital, UK.
Extracorporeal membrane oxygenation has been advocated as the most
appropriate mode of circulatory support in the paediatric age group for
post-cardiopulmonary bypass ventricular dysfunction. The results in infants
who have predominantly left ventricular failure, or who require such
support in order to be weaned off bypass, have been disappointing. Three
infants with severe left ventricular dysfunction following cardiopulmonary
bypass for correction of congenital heart defects have been managed with a
left ventricular assist device. Two required this form of circulatory
support in order to be weaned from full bypass while in the third infant it
was instituted for progressive left ventricular dysfunction
postoperatively. All three were less than 10 kg in weight. Left atrial
appendage to aortic bypass was effected using a closed loop circuit with a
constrained vortex pump (Biomedicus). Duration of support ranged between 40
and 146 h. One infant made a complete recovery and was able to be
discharged home 20 days postoperatively. Another made a circulatory
recovery such that both mechanical and inotropic support could be
discontinued but had sustained massive neurological damage. The third died
of progressive left ventricular dysfunction. This experience with a left
ventricular assist device demonstrates that it is technically feasible in
small infants, and can be performed to good effect in infants with
predominant left ventricular dysfunction following cardiac surgery. It may
well be more appropriate than extracorporeal membrane oxygenation in this
group of patients.
