e6 205 Hetzer R, Kaufmann M, Eng F, Potapov E, Krabatsch T, Delmo Walter EM Rotary blood pumps as long term mechanical circula tory support a review of a 15 year Berlin experience Semin Thorac Cardiov[.]
e6 205 Hetzer R, Kaufmann M, Eng F, Potapov E, Krabatsch T, Delmo Walter EM Rotary blood pumps as long-term mechanical circulatory support: a review of a 15-year Berlin experience Semin Thorac Cardiovasc Surg 2016;28:12-23 206 Golding LR, Harasaki H, Loop FD, Sukalac R, Reich S, Nosé Y Use of a centrifugal pump for temporary left ventricular assist system Trans Am Soc Artif Intern Organs 1978;24:93-97 207 Inoue T, Nishimura T, Murakami A, et al Left ventricular assist device support with a centrifugal pump for months in a 5-kg child J Artif Organs 2011;14:253-256 208 Filippelli S, Perri G, Kirk R, Griselli M, Hasan A Successful pediatric orthotopic heart transplantation after three runs of mechanical circulatory support Ann Thorac Surg 2013;95:2176-2178 209 Gerrah R, Charette K, Chen JM The first successful use of the Levitronix PediMag ventricular support device as a biventricular bridge to transplant in an infant J Thorac Cardiovasc Surg 2011; 142:1282-1283 210 Kumar TKS, Ballweg J, Knott-Craig CJ Lessons learned with the use of CentriMag as short-term ventricular assist device in a child Cardiol Young 2015;25:603-605 211 Wilmot I, Lorts A, Morales D Pediatric mechanical circulatory support Korean J Thorac Cardiovasc Surg 2013;46:391-401 212 Ricci M, Gaughan CB, Rossi M, et al Initial experience with the TandemHeart circulatory support system in children ASAIO J 2008;54:542-545 213 Kulat BT, Russell HM, Sarwark AE, et al Modified TandemHeart ventricular assist device for infant and pediatric circulatory support Ann Thorac Surg 2014;98:1437-1441 214 Mongé MC, Kulat BT, Eltayeb O, et al Novel Modifications of a ventricular assist device for infants and children Ann Thorac Surg 2016;102:147-153 215 Duncan BW, Fukamachi K, Noble Jr LD, et al The PediPump: a versatile, implantable pediatric ventricular assist device—update IV Artif Organs 2009;33:1005-1008 216 Conway J, Al-Aklabi M, Granoski D, et al Supporting pediatric patients with short-term continuous-flow devices J Heart Lung Transplant 2016;35:603-609 217 Geisen U, Heilmann C, Beyersdorf F, et al Non-surgical bleeding in patients with ventricular assist devices could be explained by acquired von Willebrand disease Eur J Cardiothorac Surg 2008;33:679-684 218 Balasubramanian SK, Tiruvoipati R, Amin M, et al Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support J Cardiothorac Surg 2007;2:4 219 Yarlagadda VV, Maeda K, Zhang Y, et al Temporary circulatory support in U.S children awaiting heart transplantation J Am Coll Cardiol 2017;70:2250-2260 220 Lorts A, Villa C, Riggs KW, Broderick J, Morales DLS First use of HeartMate in a failing fontan circulation Ann Thorac Surg 2018;106:e233-e234 221 Morales DLS, Dibardino DJ, McKenzie ED, et al Lessons learned from the first application of the DeBakey VAD Child: an intracorporeal ventricular assist device for children J Heart Lung Transplant 2005;24:331-337 222 Fraser CDJ, Carberry KE, Owens WR, et al Preliminary experience with the MicroMed DeBakey pediatric ventricular assist device Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006;109-114 223 Gibber M, Wu ZJ, Chang WB, et al In vivo experience of the child-size pediatric Jarvik 2000 heart: update ASAIO J 2010;56:369-376 224 Adachi I Current status and future perspectives of the PumpKIN trial Transl Pediatr 2018;7:162-168 225 Cabrera AG, Sundareswaran KS, Samayoa AX, et al Outcomes of pediatric patients supported by the HeartMate II left ventricular assist device in the United States J Heart Lung Transplant 2013; 32:1107-1113 226 Sakaguchi T, Matsumiya G, Yoshioka D, et al DuraHeart magnetically levitated left ventricular assist device: Osaka University experience Circ J 2013;77:1736-1741 227 Patel CB, Blue L, Cagliostro B, et al Left ventricular assist systems and infection-related outcomes: A comprehensive analysis of the MOMENTUM trial J Heart Lung Transplant 2020;39:774-781 228 D’Alessandro D, Forest SJ, Lamour J, Hsu D, Weinstein S, Goldstein D First reported use of the heartware HVAD in the US as bridge to transplant in an adolescent Pediatr Transplant 2012;16: E356-E359 229 VanderPluym CJ, Adachi I, Niebler R, et al Outcomes of children supported with an intracorporeal continuous-flow left ventricular assist system J Heart Lung Transplant 2019;38:385-393 230 Heatley G, Sood P, Goldstein D, et al Clinical trial design and rationale of the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate (MOMENTUM 3) investigational device exemption clinical study protocol J Heart Lung Transplant 2016;35:528-536 231 Uriel N, Colombo PC, Cleveland JC, et al Hemocompatibilityrelated outcomes in the MOMENTUM Trial at Months: a randomized controlled study of a fully magnetically levitated pump in advanced heart failure Circulation 2017;135:2003-2012 232 Chen S, Lin A, Liu E, et al outpatient outcomes of pediatric patients with left ventricular assist devices ASAIO J 2016;62:163-168 233 Blume ED, Rosenthal DN, Rossano JW, et al Outcomes of children implanted with ventricular assist devices in the United States: First analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) J Heart Lung Transplant 2016;35:578-584 234 Nguyen A, Pellerin M, Perrault LP, et al Experience with the SynCardia total artificial heart in a Canadian centre Can J Surg 2017;60:375-379 235 Morales DLS, Zafar F, Almond CS, et al Berlin Heart EXCOR use in patients with congenital heart disease J Heart Lung Transplant 2017;36:1209-1216 236 Morales DLS, Lorts A, Rizwan R, Zafar F, Arabia FA, Villa CR Worldwide Experience with the Syncardia Total Artificial Heart in the Pediatric Population ASAIO J 2017;63:518-519 237 Fukamachi K, Karimov JH, Horvath DJ, et al Initial in vitro testing of a paediatric continuous-flow total artificial heart Interact Cardiovasc Thorac Surg 2018;26:897-901 238 Bartoli CR, Koenig SC, Ionan C, et al Extracorporeal membrane oxygenation versus counterpulsatile, pulsatile, and continuous left ventricular unloading for pediatric mechanical circulatory support Pediatr Crit Care Med 2013;14:e424-e437 239 Kapur NK, Esposito M Hemodynamic support with percutaneous devices in patients with heart failure Heart Fail Clin 2015;11: 215-230 240 Char DS, Lee SSJ, Ikoku AA, Rosenthal D, Magnus D Can Destination Therapy be implemented in children with heart failure? A study of provider perceptions Pediatr Transplant 2016;20: 819-824 241 Iodice F, Testa G, Averardi M, Brancaccio G, Amodeo A, Cogo P Implantation of a left ventricular assist device as a destination therapy in Duchenne muscular dystrophy patients with end stage cardiac failure: management and lessons learned Neuromuscul Disord 2015;25:19-23 242 Miller LW, Guglin M Patient selection for ventricular assist devices: a moving target J Am Coll Cardiol 2013;61:1209-1221 243 Topilsky Y, Pereira NL, Shah DK, et al Left ventricular assist device therapy in patients with restrictive and hypertrophic cardiomyopathy Circ Heart Fail 2011;4, 266-275 244 Hasin T, Marmor Y, Kremers W, et al Readmissions after implantation of axial flow left ventricular assist device J Am Coll Cardiol 2013;61:153-163 245 Shugh SB, Riggs KW, Morales DLS Mechanical circulatory support in children: past, present and future Transl Pediatr 2019;8:269-277 246 Bates A, Buchholz H, Freed D, MacArthur R, Pi D, Borochynski T, Conway J Bivalirudin experience in a heterogeneous ventricular assist device population ASAIO J 2020;66:677-682 e7 247 Rosenthal DN, Lancaster CA, McElhinney DB, et al Impact of a modified anti-thrombotic guideline on stroke in children supported with a pediatric ventricular assist device J Heart Lung Transplant 2017;36:1250-1257 248 Karon BS, Tolan NV, Koch CD, et al Precision and reliability of platelet function tests in healthy volunteers and donors on daily antiplatelet agent therapy Clin Chem 2014;60:1524-1531 249 Nascimbene A, Neelamegham S, Frazier OH, Moake JL, Dong JF Acquired von Willebrand syndrome associated with left ventricular assist device Blood 2016;127:3133-3141 250 Philip J, Lopez-Colon D, Samraj RS, et al End-organ recovery post-ventricular assist device can prognosticate survival J Crit Care 2018;44:57-62 251 Lorts A, Eghtesady P, Mehegan M, et al Outcomes of children supported with devices labeled as ‘temporary’ or short term: a report from the Pediatric Interagency Registry for Mechanical Circulatory Support J Heart Lung Transplant 2018;37:54-60 252 Chen S, Rosenthal DN, Murray J, et al Bridge to Transplant with ventricular assist device support in pediatric patients with single ventricle heart disease ASAIO J 2020;66:205-211 253 Weinstein S, Bello R, Pizarro C, et al The use of the Berlin Heart EXCOR in patients with functional single ventricle J Thorac Cardiovasc Surg 2014;147:697-704; discussion 704-705 254 Horne D, Conway J, Rebeyka IM, Buchholz H Mechanical circulatory support in univentricular hearts: current management Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2015;18:17-24 255 Gazit AZ, Petrucci O, Manning P, et al A novel surgical approach to mechanical circulatory support in univentricular infants Ann Thorac Surg 2017;104:1630-1636 256 Morales DLS, Rossano JW, VanderPluym C, et al Third Annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report: preimplant characteristics and outcomes Ann Thorac Surg 2019;107:993-1004 257 Almond CSD, Thiagarajan RR, Piercey GE, et al Waiting list mortality among children listed for heart transplantation in the United States Circulation 2009;119:717-727 258 Jordan LC, Ichord RN, Reinhartz O, et al Neurological complications and outcomes in the Berlin Heart EXCOR(R) pediatric investigational device exemption trial J Am Heart Assoc 2015;4: e001429 259 Wehman B, Stafford KA, Bittle GJ, et al Modern outcomes of mechanical circulatory support as a bridge to pediatric heart transplantation Ann Thorac Surg 2016;101:2321-2327 260 Rossano JW, Cherikh WS, Chambers DC, et al The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-first pediatric heart transplantation report-2018; Focus theme: Multiorgan Transplantation J Heart Lung Transplant 2018;37:1184-1195 261 Dipchand AI, Kirk R, Edwards LB, et al The Registry of the International Society for Heart and Lung Transplantation: Sixteenth Official Pediatric Heart Transplantation Report—2013; focus theme: age J Heart Lung Transplant 2013;32:979-988 262 Baldwin JT, Borovetz HS, Duncan BW, Gartner MJ, Jarvik RK, Weiss WJ The national heart, lung, and blood institute pediatric circulatory support program: a summary of the 5-year experience Circulation 2011;123:1233-1240 263 Paul Collison S, Singh Dagar K The role of the Intra-aortic balloon pump in supporting children with acute cardiac failure Postgrad Med J 2007;83:308-311 264 Crowley J, Cronin B, Essandoh M, D’Alessandro D, Shelton K, Dalia AA Transesophageal Echocardiography for Impella Placement and Management J Cardiothorac Vasc Anesth 2019;33:26632668 265 Dimas VV, Morray BH, Kim DW, et al A multicenter study of the impella device for mechanical support of the systemic circulation in pediatric and adolescent patients Catheter Cardiovasc Interv 2017;90:124-129 266 Morray BH, Dimas VV, McElhinney DB, Puri K, Qureshi AM Patient size parameters to guide use of the Impella device in pediatric patients Catheter Cardiovasc Interv 2019;94:618-624 e8 Abstract: Mechanical circulatory support (MCS) is an invaluable tool in the care of children with severe refractory cardiac and/or respiratory failure Two forms of MCS are currently available to infants and small children: extracorporeal life support (ECLS) and ventricular assist devices (VADs) Patient selection, timing of intervention, and device choice continue to pose challenges in the treatment of pediatric patients This chapter reviews the basics of myocardial dysfunction in neonates and children with an emphasis on low cardiac output syndrome and its treatment, including MCS This chapter discusses indications and outcomes for ECLS in neonates with congenital heart disease; indications for MCS; salient technical details of specific devices; and patient management, present research, and future directions of these technologies for use in neonates and children Key words: heart failure, extracorporeal life support, ventricular assist device, low cardiac output syndrome, heart transplant 29 Echocardiographic Imaging M JAY CAMPBELL, MICHAEL W CAMITTA, PIERS C.A BARKER, AND GREGORY H TATUM Patients in the pediatric intensive care unit (ICU) often have hemodynamic or cardiac instability This can occur in the setting of congenital and acquired cardiovascular disease The pediatric intensivist must be aware of these disease states and be proficient in the assessment of cardiovascular status Multiple tools can be used in this assessment, including physical examination, vital signs monitoring, intravascular lines, near-infrared spectrometry, and acid-base analysis An additional tool is echocardiography, which can be invaluable in supporting the clinical evaluation of the hemodynamically compromised patient Echocardiography is the use of ultrasound to image cardiovascular structures The echocardiography probe transmits sound waves through the body and receives the reflections of these sound waves; the processor uses the data to generate an image Echocardiography arose as a widespread clinical diagnostic test in the 1970s and 1980s Previously, invasive angiography was the cardiac diagnostic test of choice Echocardiography supplanted invasive angiography because of its ability to obtain anatomic, hemodynamic, and functional data noninvasively Additional advantages of echocardiography include the absence of ionizing radiation, its portable nature, and the fact that most patients not require sedation/anesthesia Limitations include the long time it takes to perform a complete study, poor image quality in patients with greater mass, the fact that some hemodynamic and 270 • • • The intensive care unit is a unique environment for performing an echocardiogram; the intensivist, sonographer, and pediatric cardiologist must work together to obtain the needed information with minimal impact to the patient The main components of the pediatric echocardiogram are two-dimensional imaging, color Doppler, and spectral Doppler Tissue Doppler, three-dimensional imaging, and strain analysis are additional components that supplement the typical examination Cardiac point-of-care ultrasound provides an opportunity for rapid assessment of specific cardiac findings However, like transthoracic echocardiography, it is highly dependent on the technology used and expertise Many measurements standardized for use in adult patients have not been fully validated in children with or without congenital heart disease • • • • PEARLS Evaluation of volume status should include the assessment of multiple rather than single measurements and must be placed into the clinical context (e.g., baseline heart disease and physiology, intervention performed, cardiac rhythm) Echocardiography can provide a noninvasive quantitative and qualitative estimate of pulmonary artery and right ventricular systolic pressures Pericardial effusion can lead to hemodynamic compromise Echocardiography is an essential tool for the assessment of pericardial effusion and can be used to guide percutaneous drainage Pediatric patients presenting with new-onset heart failure should have echocardiographic assessment of coronary artery origins Echocardiography can diagnose most coronary artery abnormalities; however, in some patients, angiographic evaluation is necessary functional assessments are indirect measurements or calculations, and the need for a highly skilled operator These strengths and weaknesses highlight both the usefulness of echocardiography in the ICU setting and the importance of interpreting results with the knowledge of its limitations Performing an echocardiogram in the ICU is unique from the examination in the traditional echocardiography laboratory The critical nature of the patient often requires that the study be performed at the bedside Thus, the cardiac sonographer and echocardiography machine must travel to the patient The intensivist, cardiac sonographer, and pediatric cardiologist should have a preliminary conversation about the goals of the study, patient stability, and need for sedation The goal is always to maximize clinical information with minimal disturbance of the patient Sedation may be required to minimize patient agitation and instability The ICU team should work with the cardiac sonographer and pediatric cardiologist to ensure proper sedation and monitoring A complete pediatric echocardiogram is the preferred goal However, at times, a limited study with a focused clinical question can be considered in order to minimize the impact on patient stability.1 Following image acquisition and interpretation, the ICU team and the pediatric cardiologist should discuss the results in the context of the patient’s clinical status CHAPTER 29 Echocardiographic Imaging Components of the Examination An echocardiography evaluation consists of multiple tools Two-dimensional (2D) echocardiography is the backbone of the study It provides images in a still frame or video format, allowing assessment of anatomic details, valve movement, and ventricular wall motion Color Doppler images can be superimposed on 2D images to provide information about direction and velocity of blood flow Color Doppler images reveal critical information about valve function (stenosis and regurgitation) and blood flow through the cardiovascular system Spectral Doppler builds on color Doppler, allowing for quantification of velocity in a specific vector Velocity can be graphed as a function of time and the Doppler signal pattern provides important hemodynamic information (Fig 29.1) The velocity can be measured and entered into the modified Bernoulli equation to determine peak or mean gradients across valves or vessels Pressure difference (peak velocity)2 The accuracy of spectral Doppler can be limited by poor alignment of the vector to the direction of blood flow and improper probe selection Spectral Doppler gradients may not always match 271 gradients measured at cardiac catheterization This can be true because of a number of variables—such as sedation status, peak instantaneous gradients versus peak-to-peak gradients, and pressure recovery phenomena.2,3 These echocardiographic measurements must be interpreted in the setting of other clinical and echocardiographic findings 2D echocardiography, color Doppler, and spectral Doppler are the primary components of the pediatric echocardiogram Additional components of a pediatric echocardiogram include tissue Doppler, three-dimensional (3D) imaging, and strain analysis Tissue Doppler measures the velocity of the myocardium at the level of the atrioventricular valves The velocities and the timing of myocardial motion provide important information about diastolic ventricular function and electrical-mechanical coupling.4,5 3D imaging can provide important ancillary information, including quantification of left ventricular systolic function (Fig 29.2).6 3D imaging can also provide high-quality anatomic information, particularly regarding atrioventricular valves.7 Strain imaging evaluates the deformation of myocardium and can provide information about regional and global systolic function, allowing for the detection of subclinical changes in ventricular function.8,9 Modalities Transthoracic Echocardiography • Fig 29.1 Spectral Doppler across the right ventricular outflow tract in a patient with repaired tetralogy of Fallot depicting pulmonary regurgitation Transthoracic echocardiography is the clinical workhorse of pediatric cardiac imaging This consists of placing the probe directly on the patient’s chest wall and abdomen and transmitting/ receiving ultrasound Its noninvasive nature makes it a readily available imaging modality with minimal risk Image spatial resolution and quality are improved with high-frequency probes; however, high-frequency probes have limited penetration Higher-frequency probes can generate images of excellent quality in patients with smaller mass, such as young children Patients with greater mass require lower-frequency probes with increased penetration; however, image quality and spatial resolution are sacrificed Any material between the probe and the patient—such as bandages, electrocardiography (ECG) leads, chest tubes, and pacing wires–can limit transthoracic echocardiography image quality • Fig 29.2 Three-dimensional left ventricle functional assessment and ejection fraction measurement in a patient with depressed systolic function ... al Third Annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report: preimplant characteristics and outcomes Ann Thorac Surg 2019;107:993-1004 257 Almond CSD, Thiagarajan... pediatric patients This chapter reviews the basics of myocardial dysfunction in neonates and children with an emphasis on low cardiac output syndrome and its treatment, including MCS This chapter discusses... Patients in the pediatric intensive care unit (ICU) often have hemodynamic or cardiac instability This can occur in the setting of congenital and acquired cardiovascular disease The pediatric intensivist