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Fourth Annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report
David L S Morales1, Iki Adachi2, David M Peng3
1Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Pediatric mechanical circulatory support using ventricular assist devices (VADs) shows improved outcomes, especially with implantable continuous (IC) pumps. Patient condition at implantation significantly impacts VAD success rates.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Biomedical Engineering
Background:
- The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) database tracks children receiving ventricular assist devices (VADs).
- Increasing use of VADs in pediatrics is driven by new technologies, broader indications, and better outcomes.
- Pedimacs provides critical data on this evolving field.
Purpose of the Study:
- To analyze the characteristics and outcomes of pediatric patients supported by VADs.
- To compare different types of VADs (implantable continuous, paracorporeal continuous, paracorporeal pulsatile) in pediatric populations.
- To identify factors influencing VAD outcomes in children.
Main Methods:
- Data collected from 44 hospitals between September 2012 and December 2019.
- Analysis of 1031 VAD implants in 856 patients under 19 years old.
- Comparison of patient demographics, diagnoses, and VAD types (IC, PC, PP).
Main Results:
- Cardiomyopathy (58%) and congenital heart disease (25%) were primary diagnoses.
- Overall 6-month positive outcome rate was 82%.
- Implantable continuous (IC) pumps showed higher 6-month positive outcomes (92%) and lower cerebrovascular accident rates (7%) compared to paracorporeal devices.
Conclusions:
- IC VADs are the most common and associated with better outcomes in pediatric patients.
- Paracorporeal devices are used for more complex cases.
- Patient condition at VAD implantation is a key determinant of mortality and adverse events, more so than age, size, or device type.
Background:
The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), originally a National Institutes of Health-sponsored U.S. database, provides a platform to understand the population of children supported with ventricular assist devices (VADs) during this time of increasing numbers, new devices, expanding indications, and improved outcomes.
Methods:
Between September 19, 2012, and December 31, 2019, 44 hospitals implanted 1031 devices in 856 patients under 19 years of age.
Results:
Overall, diagnosis was cardiomyopathy in 497 (58%) patients, congenital heart disease (CHD) in 216 (25%), myocarditis in 85 (10%), and other in 58 (7%). Positive outcome (alive on device or bridge to transplantation and recovery) occurred in 82% at 6 months. The patient cohort for implantable continuous (IC) pumps (n = 365) (age 13.2 ± 3.9 years, 18% Interagency Registry for Mechanically Assisted Circulatory Support [Intermacs] profile 1, 23% intubated at implantation, 16% with CHD) was significantly different from the paracorporeal continuous (PC) pump cohort (n = 212) (age 3.6 ± 4.9 years, 46% Intermacs profile 1, 81% intubated, 42% CHD) and the paracorporeal pulsatile (PP) pump cohort (n = 230) (age 2.7 ± 3.5 years, 31% Intermacs profile 1, 76% intubated, 26% CHD). Consistent with their cohort composition, positive outcomes at 6 months based on device type were the following: IC, 92%; PC, 68%; and PP, 81%. The incidence of cerebrovascular accidents in the IC, PC, and PP cohorts was 7%, 14%, and 15%, respectively.
Conclusions:
IC VADs, the most common VAD type placed in children, are associated with improved outcomes compared with PP and PC devices, though PP and PC devices are limited to supporting our most challenging patients. Noteworthy, the incidence of cerebrovascular accidents for pediatric VADs has significantly decreased and is now 11% overall. This report demonstrates again that although often attributed to age, size, or device type, much of the burden in mortality and adverse events is correlated to the patient's overall state at VAD implantation.
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