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Implantation of Left Ventricular Assist Device (LVAD) in Juvenile Landrace Swine: A LVAD Implantation Model of Pediatric Heart Failure
Published on: January 16, 2026
Predictors of in-hospital mortality in children after long-term ventricular assist device insertion
Ye Fan1, Yu-Guo Weng, Micheal Huebler
1Department of Cardiovascular Surgery, Chongqing Xinqiao Hospital, Third Military Medical University, Xinqiao Street 1, Chongqing, China. fanye2008728@googlemail.com
Insights
Pre-implantation factors like congenital heart disease, norepinephrine use, high C-reactive protein, and elevated central venous pressure predict in-hospital mortality in pediatric ventricular assist device (VAD) patients. Careful patient selection is crucial for better outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Ventricular assist device (VAD) implantation is critical for pediatric end-stage heart failure.
- Understanding pre-implantation risk factors for in-hospital mortality in pediatric VAD recipients is essential for improving survival rates.
- Current knowledge on predictors of post-VAD survival in children remains limited.
Purpose of the Study:
- To identify pre-implantation predictors of in-hospital mortality in children receiving VAD support.
- To enhance candidate selection criteria for pediatric VAD implantation.
- To inform timing strategies for VAD insertion in pediatric heart failure.
Main Methods:
- Retrospective analysis of 92 pediatric patients who underwent long-term VAD implantation from June 1996 to December 2009.
- Multivariate logistic regression analysis was used to identify pre-operative risk factors associated with in-hospital survival.
- Data collected included patient demographics, etiology of heart failure, and pre-operative clinical parameters.
Main Results:
- The overall survival rate to transplantation or ventricular recovery was 63% among the 92 pediatric VAD patients.
- Independent predictors of in-hospital mortality included congenital etiology (OR: 11.2), norepinephrine requirement (OR: 6.9), C-reactive protein >6.3 mg/dl (OR: 4.9), and central venous pressure >17 mm Hg (OR: 4.6).
- Median age at implantation was 7 years, with a median support time of 35 days.
Conclusions:
- Congenital etiology, pre-operative need for norepinephrine, elevated C-reactive protein, and high central venous pressure are significant predictors of in-hospital mortality in pediatric VAD recipients.
- Optimizing candidate selection and the timing of VAD implantation are crucial for improving outcomes in children with advanced heart failure.
- These findings can guide clinical decision-making for pediatric VAD therapy.
Objectives:
This study aimed to determine the pre-implantation predictors for in-hospital mortality in children with ventricular assist device (VAD) support.
Background:
Candidate selection is of critical importance for improved outcomes in patients supported with VAD. However, risk factors for post-VAD survival in children are still not clearly understood.
Methods:
From June 1996 to December 2009, 92 children underwent implantation of a long-term VAD at Germany Heart Institute Berlin. Data on all these patients were retrospectively analyzed, and pre-operative risk factors for in-hospital survival after VAD implantation were identified by multivariate logistic regression.
Results:
Of the 92 subjects, the median age at implantation was 7 years (range 12 days to 18 years), and the median support time was 35 days (range 1 to 591 days). The overall survival rate to transplantation or recovery of ventricular function was 63%. Independent predictors of in-hospital mortality in children included congenital etiology (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 2.6 to 47.5), norepinephrine requirement (OR: 6.9; 95% CI: 1.4 to 31), C-reactive protein level >6.3 mg/dl (OR: 4.9; 95% CI: 1.1 to 22.1), and central venous pressure >17 mm Hg (OR: 4.6; 95% CI: 1.1 to 20).
Conclusions:
Congenital etiology, pre-operative norepinephrine requirement, higher serum C-reactive protein, and central venous pressure were associated with increased in-hospital mortality in children with VAD support. Optimal candidate selection and timing of VAD insertion may be of great importance for improved outcomes in children with advanced heart failure.
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