Long-term follow-up of pediatric cardiac patients requiring mechanical circulatory support

Background. The present study examines the long-term outcome of pediatric p atients with cardiac disease who required mechanical circulatory support wi th extracorporeal membrane oxygenation or ventricular assist devices. Methods. Telephone interviews and questionnaires were administered to paren ts and physicians of pediatric cardiac patients who were in-hospital surviv ors after requiring mechanical circulatory support, with either extracorpor eal membrane oxygenation or ventricular assist devices. Data was collected regarding these patients' general health, cardiac status, and neurologic ou tcome, and compared between the two modes of support. Results. Follow-up was available for 26 patients supported with extracorpor eal membrane oxygenation (25 survivors, 96%) and 11 patients supported with ventricular assist devices (10 survivors, 91%); median follow-up 42 months , 11 to 92 months). More than 80% of survivors were in New York Heart Assoc iation class I or II. Of 31 patients for whom neurologic assessment data wa s available, moderate to severe neurologic impairment was more common for e xtracorporeal membrane oxygenation supported patients [13 of 21, 59%) than for ventricular assist device supported patients (2 of 10, 20% p = 0.03). N eurologic impairment was associated with small patient size and the use of circulatory arrest during cardiac surgical repair, but was not associated w ith in-hospital neurologic complications, carotid cannulation, or presuppor t cardiac arrest. Conclusions. The long-term survival and cardiac functional status of pediat ric cardiac patients requiring mechanical circulatory support is favorable. Extracorporeal membrane oxygenation supported patients demonstrate higher rates of neurologic impairment than patients supported with ventricular ass ist devices. Poor neurologic outcomes are associated with institution of su pport in younger patients with more complex congenital heart disease. (C) 2 000 by The Society of Thoracic Surgeons.