MECHANICAL CIRCULATORY SUPPORT FOR POST CARDIOTOMY CARDIOGENIC-SHOCK IN INFANTS

Eleven infants weighing 2.3 to 7.8 kg underwent mechanical circulatory support for post cardiotomy cardiogenic shock. Initiated pre-operativ ely in two patients, extracorporeal membrane oxygenation was used in a total of eight patients aged 6 days to 3 months in association with r epair of cyanotic congenital heart disease with increased pulmonary bl ood flow or with a right sided obstructive lesion. Ventricular assist devices were used in three other patients: a centrifugal left ventricu lar assist device in Patient 1 (10 months, 5.7 kg) after repair of the anomalous left coronary artery, and a pneumatic biventricular assist device (stroke volume 12 ml) in Patient 2 (6 months, 7.0 kg) for cardi ac arrest after closure of ventricular septal defect and in Patient 3 (10 months, 7.8 kg) for post transplant graft failure. Duration of ext racorporeal membrane oxygenation duration ranged from 26 to 192 hr (me an, 88 hr). Three patients were weaned from extracorporeal membrane ox ygenation and two survived. Two others were separated from extracorpor eal membrane oxygenation because of bleeding, but both subsequently di ed. Patient 1 was weaned from the left ventricular assist device after 192 hr and discharged from the hospital. Support was discontinued aft er 45 hr in Patient 2 who exhibited irreversible brain damage. Patient 3 was weaned from a biventricular assist device after 174 hr, but suf fered recurrent graft failure. Our results show that an appropriate ci rculatory support system should be selected according to the cardiac a natomy in infants.