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Cerebrovascular accidents in paediatric patients supported by the Berlin Heart EXCOR
Sofie Rohde1, Eugen Sandica2, Kevin Veen1
1Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Insights
Cerebrovascular accidents occurred in 20% of pediatric patients on Berlin Heart EXCOR support, with pump thrombosis and need for a second device being key risk factors. Mortality rates decreased, and recovery rates were encouraging.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Neurology
Background:
- Ventricular assist device (VAD) support is a critical therapy for children awaiting cardiac transplantation.
- The Berlin Heart EXCOR is a widely used VAD in pediatric patients.
- Cerebrovascular accidents (CVAs) are a significant concern in patients with VADs.
Purpose of the Study:
- To investigate the incidence of cerebrovascular accidents (CVAs) in pediatric patients supported by the Berlin Heart EXCOR ventricular assist device.
- To identify factors associated with CVAs in this patient population.
Main Methods:
- Retrospective analysis of pediatric patients (<19 years) supported by Berlin Heart EXCOR from January 2011 to January 2021.
- Data sourced from the European Registry for Patients with Mechanical Circulatory Support.
- Statistical analysis to determine incidence and associated factors for CVAs.
Main Results:
- Of 230 patients, 46 (20.0%) experienced 55 CVAs, with 70.9% occurring within 90 days of VAD implantation.
- Pump thrombosis (HR 1.998, P=0.040) and the need for a secondary right ventricular assist device (HR 11.300, P=0.037) were significantly associated with CVAs.
- One-year outcomes included 44.4% transplant, 13.1% weaned, and 24.5% mortality, with a decreasing trend in mortality rates.
Conclusions:
- Pediatric VAD support, particularly early after implantation, is linked to adverse events like CVAs.
- Pump thrombosis and the need for a secondary RVAD are identified as significant risk factors for CVAs.
- Encouraging recovery rates and declining mortality highlight the benefits, though improved data registry completeness is needed.
Objectives:
Ventricular assist device support as a bridge to transplant or recovery is a well-established therapy in children on the cardiac transplant waiting list. The goal of this study was to investigate the incidence of and the associated factors for cerebrovascular accidents in paediatric patients supported by a Berlin Heart EXCOR.
Methods:
All patients <19 years of age supported by a Berlin Heart EXCOR between January 2011 and January 2021 from the European Registry for Patients with Mechanical Circulatory Support were included.
Results:
In total, 230 patients were included. A total of 140 (60.9%) patients had a diagnosis of dilated cardiomyopathy. 46 patients (20.0%) sustained 55 cerebrovascular accidents, with 70.9% of the episodes within 90 days after the ventricular assist device was implanted. The event rate of cerebrovascular accidents was highest in the first era (0.75). Pump thrombosis and secondary need for a right ventricular assist device were found to be associated with a cerebrovascular accident (hazard ratio 1.998, P = 0.040; hazard ratio 11.300, P = 0.037). At the 1-year follow-up, 44.4% of the patients had received a transplant, 13.1% were weaned after recovery and 24.5% had died. Event rates for mortality showed a significantly decreasing trend.
Conclusions:
Paediatric ventricular assist device support is associated with important adverse events, especially in the early phase after the device is implanted. Pump thrombosis and the need for a secondary right ventricular assist device are associated with cerebrovascular accidents. Furthermore, an encouragingly high rate of recovery in this patient population was shown, and death rates declined. More complete input of data into the registry, especially concerning anticoagulation protocols, would improve the data.
