TY - JOUR
T1 - Improved early outcome for end-stage dilated cardiomyopathy in children
AU - McMahon, Anne Marie
AU - Van Doorn, Carin
AU - Burch, Michael
AU - Whitmore, Pauline
AU - Neligan, Sophie
AU - Rees, Philip
AU - Radley-Smith, Rosemary
AU - Goldman, Allan
AU - Brown, Katherine
AU - Cohen, Gordon
AU - Tsang, Victor
AU - Elliott, Martin
AU - Huddleston, Charles B.
AU - Vargas, Florentino J.
AU - Backer, Carl L.
AU - De Leval, Marc R.
AU - Jonas, Richard A.
AU - Troconis, Carlos J.
PY - 2003/12
Y1 - 2003/12
N2 - Objective: To review the impact of management changes on the early outcomes of end-stage dilated cardiomyopathy in children. Methods: We conducted a retrospective study of all consecutive children with end-stage dilated cardiomyopathy who received hospital treatment since 1992. Over the past 3 years the following management changes were made: (1) more aggressive use of mechanical cardiac assistance; (2) high priority listing for transplantation; and (3) ABO incompatible transplants for infants. Outcomes for 46 patients admitted between 1992 and 1999 (group I) were compared with 53 patients between 2000 and March 2003 (group II). Results: In group I, 12 (26%) patients received mechanical support with recovery in 3 and transplantation in 5 (1 died). In group II, 19 (36%) patients received extracorporeal membrane oxygenation, with recovery in 5 and transplantation in 12 (all survived). The use of mechanical assistance was associated with high morbidity related to bleeding, end-organ failure, and long-term mechanical ventilation. Five patients in group II received ABO incompatible transplants and all survived. There have been no episodes of rejection or need for increased immunosuppressive therapy. Hospital mortality has been significantly reduced (group I, 37% vs group II, 11%; P < .05). Conclusions: Recent refinements in the management of end-stage dilated cardiomyopathy in children have significantly reduced early mortality. Identification of markers of early myocardial recovery and development of mechanical devices for longer term and more physiologic support are essential to achieve further improvements in outcome.
AB - Objective: To review the impact of management changes on the early outcomes of end-stage dilated cardiomyopathy in children. Methods: We conducted a retrospective study of all consecutive children with end-stage dilated cardiomyopathy who received hospital treatment since 1992. Over the past 3 years the following management changes were made: (1) more aggressive use of mechanical cardiac assistance; (2) high priority listing for transplantation; and (3) ABO incompatible transplants for infants. Outcomes for 46 patients admitted between 1992 and 1999 (group I) were compared with 53 patients between 2000 and March 2003 (group II). Results: In group I, 12 (26%) patients received mechanical support with recovery in 3 and transplantation in 5 (1 died). In group II, 19 (36%) patients received extracorporeal membrane oxygenation, with recovery in 5 and transplantation in 12 (all survived). The use of mechanical assistance was associated with high morbidity related to bleeding, end-organ failure, and long-term mechanical ventilation. Five patients in group II received ABO incompatible transplants and all survived. There have been no episodes of rejection or need for increased immunosuppressive therapy. Hospital mortality has been significantly reduced (group I, 37% vs group II, 11%; P < .05). Conclusions: Recent refinements in the management of end-stage dilated cardiomyopathy in children have significantly reduced early mortality. Identification of markers of early myocardial recovery and development of mechanical devices for longer term and more physiologic support are essential to achieve further improvements in outcome.
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U2 - 10.1016/j.jtcvs.2003.07.029
DO - 10.1016/j.jtcvs.2003.07.029
M3 - Article
C2 - 14688687
AN - SCOPUS:9144241834
SN - 0022-5223
VL - 126
SP - 1781
EP - 1787
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -