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Updated: Aug 11, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Short- and long-term survival of children treated with ventricular assist devices in Spain, based on 15 years'
Juan José Menéndez1, Amelia Caridad Sánchez-Galindo2, Joan Balcells3
1Pediatric Critical Care Department, Hospital Universitario La Paz, Madrid, Spain.
Insights
In Spain, 67% of pediatric ventricular assist device (VAD) patients survived to transplant or recovery. Low body weight, congenital heart disease, and pre-implantation cardiac arrest were linked to higher mortality.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Technology
Background:
- Ventricular assist devices (VADs) are crucial for managing pediatric heart failure.
- Understanding survival outcomes and associated risk factors in pediatric VAD recipients is essential for improving patient care.
Purpose of the Study:
- To describe the utilization of VADs in children within Spain.
- To identify factors influencing survival rates in pediatric VAD recipients.
Main Methods:
- An observational cohort study was conducted retrospectively.
- Data were collected from 6 Spanish pediatric heart transplant centers between May 2006 and December 2020.
- The study included all children under 18 years who received an initial VAD implantation.
Main Results:
- A total of 118 children received paracorporeal VADs (pulsatile, continuous, or both).
- The majority of recipients were small children (63.3% <0.7 m² body surface area).
- Overall survival to VAD explantation was 67%, and survival to hospital discharge was 64.9%.
- Common complications included hemorrhage (39%) and stroke (38.1%).
- Factors associated with increased mortality included low body weight (<5 kg), congenital heart disease, high pre-implantation bilirubin (>34 μmol/l), and a bridge-to-decision strategy.
- INTERMACS status 1 and pre-implantation cardiac arrest were linked to long-term mortality.
Conclusions:
- 67% of VAD-supported children in Spain were successfully bridged to heart transplantation or recovery.
- Key pre-implantation variables associated with mortality were low body weight, congenital heart disease, cholestatic liver dysfunction, bridge-to-decision strategy, INTERMACS-1 status, and cardiac arrest.
- Pre-implantation renal replacement therapy and extracorporeal membrane oxygenation were not found to be related to mortality.
Objectives:
To describe the use of ventricular assist devices (VAD) in children in Spain and to identify variables related to survival.
Methods:
This is an observational cohort study of all children younger than 18 years of age who underwent an initial implantation of a VAD at any of the 6 paediatric heart transplant centres from May 2006 to December 2020. Subjects were identified retrospectively from each hospital's database.
Results:
Paracorporeal VADs were implanted in 118 children [pulsatile (63%), continuous (30.5%) or both types (5.9%)]. Small children (<0.7 m2 of body surface area) comprised the majority of this cohort (63.3%). Overall, 67% survived to VAD explantation, and 64.9% survived to hospital discharge. Non-central nervous system haemorrhage (39%) and stroke (38.1%) were the most common complications. Body weight <5 kg, congenital heart disease, pre-implantation bilirubin >34 μmol/l and bridge to decision strategy were associated with a higher mortality at hospital discharge and in the long-term. Interagency registry for mechanically assisted circulatory support (INTERMACS) status 1 and cardiac arrest prior to VAD implantation were related to long-term mortality, whereas pre-implantation renal replacement therapy and extracorporeal membrane oxygenation were not related to mortality.
Conclusions:
In Spain, 67% of the VAD-supported children have been bridged to heart transplantation or to recovery. Body weight lower than 5 kg, congenital heart disease diagnosis, cholestatic liver dysfunction, bridge to decision as VAD strategy, INTERMACS-1 status and cardiac arrest were pre-implantation variables related to mortality, whereas pre-implantation renal replacement therapy and extracorporeal membrane oxygenation were not.
