Circulatory support in infants with post-cardiopulmonary bypass left ventricular dysfunction using a left ventricular assist device

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Abstract
Extracorporeal membrane oxygenation has been advocated as the mostappropriate mode of circulatory support in the paediatric age group forpost-cardiopulmonary bypass ventricular dysfunction. The results in infantswho have predominantly left ventricular failure, or who require suchsupport in order to be weaned off bypass, have been disappointing. Threeinfants with severe left ventricular dysfunction following cardiopulmonarybypass for correction of congenital heart defects have been managed with aleft ventricular assist device. Two required this form of circulatorysupport in order to be weaned from full bypass while in the third infant itwas instituted for progressive left ventricular dysfunctionpostoperatively. All three were less than 10 kg in weight. Left atrialappendage to aortic bypass was effected using a closed loop circuit with aconstrained vortex pump (Biomedicus). Duration of support ranged between 40and 146 h. One infant made a complete recovery and was able to bedischarged home 20 days postoperatively. Another made a circulatoryrecovery such that both mechanical and inotropic support could bediscontinued but had sustained massive neurological damage. The third diedof progressive left ventricular dysfunction. This experience with a leftventricular assist device demonstrates that it is technically feasible insmall infants, and can be performed to good effect in infants withpredominant left ventricular dysfunction following cardiac surgery. It maywell be more appropriate than extracorporeal membrane oxygenation in thisgroup of patients.

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