Improved early outcome for end-stage dilated cardiomyopathy in children

Anne Marie McMahon, Carin Van Doorn*, Michael Burch, Pauline Whitmore, Sophie Neligan, Philip Rees, Rosemary Radley-Smith, Allan Goldman, Katherine Brown, Gordon Cohen, Victor Tsang, Martin Elliott, Charles B. Huddleston, Florentino J. Vargas, Carl L. Backer, Marc R. De Leval, Richard A. Jonas, Carlos J. Troconis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1781-1787
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume126
Issue number6
DOIs
StatePublished - Dec 2003

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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