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Updated: Nov 10, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Stroke in pediatric ventricular assist device patients-a pedimacs registry analysis
Robert A Niebler1, Shahnawaz Amdani2, Betsy Blume3
1Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
Insights
Cerebrovascular accidents (CVA) remain a concern in pediatric ventricular assist device (VAD) support, affecting over 10% of patients. While recent data show improvement, CVA significantly increases mortality risk, necessitating focus on pre-implant and early support phases.
Area of Science:
- Pediatric Cardiology
- Neurology
- Biomedical Engineering
Background:
- Cerebrovascular accidents (CVA) are significant complications in pediatric patients requiring ventricular assist devices (VADs).
- Understanding the incidence, risk factors, and outcomes of CVA is crucial for improving VAD support in children.
Purpose of the Study:
- To investigate the rates, risk factors, and outcomes of CVA in pediatric VAD recipients.
- To analyze trends and identify protective factors in CVA occurrence.
Main Methods:
- Utilized data from the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) from September 2012 to June 2019.
- Analyzed neurologic events, specifically CVA, using a multiphase parametric hazard model to identify risk factors.
- Compared outcomes, including mortality, between patients with and without CVA.
Main Results:
- Out of 662 patients, 71 (10.7%) experienced 87 CVA events.
- Paracorporeal pulsatile VADs showed a higher proportion of patients with CVA but a lower rate compared to continuous VADs.
- Ascites, higher patient profile, and implantation at low-volume centers were associated with CVA; recent era and intracorporeal continuous implants were protective.
- Mortality was significantly higher in patients who experienced a CVA.
Conclusions:
- CVA remains a critical issue in pediatric VAD support, despite a decrease in overall incidence to below 11%.
- Recent data suggest encouraging trends, but CVA is still strongly linked to increased mortality.
- Future research and clinical efforts should concentrate on the pre-implant phase and the early stages of VAD support to mitigate CVA risks.
Background:
Cerebralvascular accidents (CVA) are common complications of pediatric ventricular assist devices (VADs). We employed the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) to investigate rates, risk factors, and outcomes of CVA in pediatric patients supported on VAD.
Methods:
Analysis of Pedimacs (September 2012-June 2019) data to determine rates of all neurologic events and specifically CVA. Risk factors were determined by a multiphase parametric hazard model. Outcomes of patients with CVA were compared with patients without CVA.
Results:
We included 662 patients in our analysis. In total, 87 CVA events occurred in 71 patients (10.7%). The proportion of patients with CVA was highest in the paracorporeal pulsatile group (16.9%) followed by the paracorporeal continuous group (10.4%). However, the rate of CVA was lower in the paracorporeal pulsatile group compared to the paracorporeal continuous group (6.4 vs 11.1 events/100 patient months), which reflects differences in support duration. Ascites, higher patient profile groups, and implants within small volume centers were associated with the occurrence of CVA. Our analysis found that the recent era (i.e., June 2017), and intracorporeal continuous implants were protective. Mortality was higher in patients following a CVA diagnosis compared to those without a CVA diagnosis.
Conclusions:
CVA continues to be a problem in pediatric VAD support, though the overall percent is now <11%. Data from the most recent era are encouraging, but CVA is still significantly associated with mortality. Future efforts should focus on pre-implant and early support periods.
