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The Use of Levitronix CentriMag® in the Pediatric Population
Session:
CO 16 - Congénitos
Speaker:
Catarina Perez Brandão
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.7 Pediatric Cardiology
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Catarina Perez Brandão; Conceição Trigo; Rui Rodrigues; Maria De Fátima Pinto; José Fragata
Abstract
<p><strong>INTRODUCTION</strong></p> <p>Short-term mechanical circulatory support (MCS) is used in children with severe heart failure and refractory cardiogenic shock in an attempt to improve hemodynamic condition and provide a bridge to recovery or heart transplantation. The Levitronix CentriMag® is a magnetically levitated rotary continuous-flow pump designed for temporary left, right or biventricular support, with a lower risk of blood stasis and hemolysis.</p> <p><strong>METHODS </strong></p> <p>Retrospective analysis to evaluate the efficacy, safety and clinical outcomes of Levitronix CentriMag® use in a pediatric population. Clinical status and biomarkers were analyzed in all children before and after ventricular assist device (VAD) implantation.</p> <p><strong>RESULTS</strong></p> <p>Levitronix CentriMag® devices were implanted in three children with dilated cardiomyopathy, end-stage heart failure and critical cardiogenic shock (Pedimacs 1 profile). Two patients were male and one female. The minimum age was 7 years old and the maximum age was 15 years old. All children experienced biventricular dysfunction, inotrope-dependence and deteriorating end-organ function, with high levels of BNP (mean 1640 pg/mL), liver enzymes and a need for high-dose furosemide perfusion to maintain urine output. No patient needed renal replacement therapy. One patient was managed with extracorporeal membrane oxygenation (ECMO) support for 14 days, before VAD implantation. All patients underwent Levitronix CentriMag® placement for left ventricular assistance (LVAD) and were listed for heart transplantation. The minimum time of LVAD support was 6 days and the maximum was 19 days. Two patients were extubated 24 hours after LVAD implantation and one patient remained on mechanical ventilation. All patients required inotropic support for the right ventricle. Two patients experienced complications, both hemorrhagic with cardiac tamponade and thrombotic with atrial cannula thrombus formation and ischemic stroke. All three patients were successfully bridged to heart transplantation.</p> <p><strong>CONCLUSIONS</strong></p> <p>The Levitronix CentriMag® system seems to be an efficient, short-term VAD in pediatric setting, although there are few reports about its use. Thrombotic / hemorrhagic complications are the main challenge in these patients as seen in other mechanical assist devices.</p>
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