Post-cardiotomy mechanical circulatory support using a conventional bypass circuit in children.

OBJECTIVE

Mechanical circulatory support (MCS) is increasingly used after cardiotomy in children when conventional medical treatment fails. Poor overall survival and long-term outcome have been reported. We report our experience of post-cardiotomy MCS using a conventional bypass circuit.

METHODS

Over a 4 year and 6 month period 10 patients, with a median age of 16 days (range 5 days to 16 years) required MCS. Eight patients required support for failure to wean from cardiopulmonary bypass during primary correction. Two patients required support for cardiac arrest or poor cardiac output in the postoperative period.

RESULTS

The median duration of support was 43 h (range 26-146 h). Seven hospital survivors were alive and well at median follow-up of 18 months (range 4-36 months). One patient could not be weaned off support. Two more patients died after successful weaning from support. Complications in nine patients who could be weaned off support included renal failure (n=6), cerebrovascular events (n=3) and mediastinitis (n=2).

CONCLUSIONS

Overall long-term survival (70%) and quality of recovery is usually good even though initial mortality and complication rates may be high. We think that post cardiotomy mechanical circulatory bypass using a conventional bypass circuit can offer a favourable outcome to selected patients.