Minimally invasive mechanical cardiac support without extracorporeal membrane oxygenation in children awaiting heart transplantation

Background. Mechanical cardiac assist for small children (< 30 kg) requirin g bridge strategy to orthotopic heart transplantation often requires sterno tomy for cannulation access to ensure perfusion to the aortic arch. Extraco rporeal membrane oxygenation (ECMO) through neck cannulation is an option i n very small(< 10 kg) patients, but the risk of stroke is increased in larg er children. Another disadvantage is poor decompression of the left atrium, which can cause persistent pulmonary edema. Methods. Two cases are used to illustrate two methods of avoiding sternotom y during mechanical assist in children with dilated cardiomyopathy. One of these approaches avoids the need for extracorporeal oxygenation. Results. Decompression of the left-sided chambers with a left atrial cannul a decreased pulmonary edema and improved pulmonary function. Conclusions. Pediatric patients with dilated cardiomyopathy may benefit fro m a left ventricular assist technique using a centrifugal pump, which avoid s the neck vessels and sternotomy, as well as ECMO. (C) 1999 by The Society of Thoracic Surgeons.