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Decreased Risk of Strokes in Children with Ventricular Assist Devices Within ACTION

David M Peng1, Muhammad F Shezad2, Angela Lorts2

  • 1University of Michigan Congenital Heart Center, CS Mott Children's Hospital, Ann Arbor, MI, USA. davepeng@med.umich.edu.

Pediatric Cardiology
|March 5, 2022
PubMed

Insights

Pediatric strokes occurred in 11% of children with ventricular assist devices (VADs), with many happening early after implantation. This highlights the need for focused stroke prevention strategies in high-risk pediatric VAD patients.

Area of Science:

  • Pediatric Cardiology
  • Neurology
  • Medical Devices

Background:

  • Ventricular assist devices (VADs) are critical for pediatric heart failure management.
  • Stroke is a significant complication in pediatric VAD recipients.
  • Characterizing stroke patterns is essential for improving outcomes.

Purpose of the Study:

  • To characterize the incidence, timing, and risk factors of strokes in children supported by VADs.
  • To identify patient subgroups at higher risk for stroke.
  • To inform strategies for stroke prevention in this population.

Main Methods:

  • Analysis of data from the ACTION registry (April 2018 - May 2021).
  • Inclusion of 407 pediatric patients with VADs.
  • Review of stroke events (ischemic and hemorrhagic) and associated patient characteristics.

Main Results:

  • 52 strokes occurred in 45 patients (11% incidence).
  • Median time to stroke was 23.5 days; 37% occurred within 10 days.
  • Higher stroke rates were observed with paracorporeal devices compared to continuous-flow devices.
  • Younger patients, those with congenital heart disease, and those on extracorporeal membrane oxygenation were at increased risk.

Conclusions:

  • Stroke is a notable complication in pediatric VAD patients, particularly in the early post-implantation period.
  • Specific patient populations (younger, congenital heart disease, ECMO) require heightened monitoring.
  • The ACTION registry is focusing on reducing strokes in high-risk pediatric VAD recipients, especially around the time of implantation.

Keywords:
PediatricsQuality improvementStrokeVentricular assist devices

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