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Seventh Annual Society of Thoracic Surgeons Pedimacs Report
David M Peng1, Ryan R Davies2, Kathleen E Simpson3
1Department of Pediatrics, University of Michigan Medical School, Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
Insights
The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) shows ventricular assist devices (VADs) are vital for children. Implantable continuous VADs offer the best outcomes, highlighting the need for tailored device selection.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiac Surgery
Background:
- The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) collects data on pediatric patients requiring ventricular assist devices (VADs).
- Supported by The Society of Thoracic Surgeons, Pedimacs is a crucial resource for understanding VAD use in children.
Purpose of the Study:
- To analyze trends and outcomes of VAD implantation in pediatric patients.
- To evaluate the effectiveness of different VAD types in children.
Main Methods:
- Data from 1463 VAD implantations in 1219 pediatric patients (<19 years) were collected between September 2012 and December 2022.
- The registry included 40 North American hospitals, reporting on various VAD types and patient etiologies.
Main Results:
- Cardiomyopathy (59%) was the leading cause for VADs, followed by congenital heart disease (26%).
- Implantable continuous devices (39%) were most frequent, showing a 92% favorable outcome at 6 months.
- Paracorporeal continuous devices had a 68% favorable outcome, though patient populations differed.
Conclusions:
- Ventricular assist devices (VADs) are essential in treating pediatric heart failure.
- Different VAD types, including paracorporeal continuous, paracorporeal pulsatile, and implantable continuous devices, are utilized based on patient complexity.
- Preoperative factors and patient population differences influence survival rates, underscoring the need for continued research and collaborative efforts.
Background:
The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), supported by The Society of Thoracic Surgeons, provides detailed information on pediatric patients supported with ventricular assist devices (VADs).
Methods:
From September 19, 2012, to December 31, 2022, 1463 devices in 1219 patients aged <19 years were reported to the registry from 40 North American hospitals.
Results:
Cardiomyopathy remains the most common underlying etiology (59%), followed by congenital heart disease (26%) and myocarditis (8%). Implantable continuous devices were most common (39%) type, followed by paracorporeal pulsatile (28%) and paracorporeal continuous (27%) devices. At 6 months after VAD implantation, a favorable outcome (transplant, recovery, or alive on device) was achieved in 85% of patients, which was greatest among those on implantable continuous VADs (92%) and least for paracorporeal continuous VADs (68%), although the patient population supported on these devices is different.
Conclusions:
This Seventh Pedimacs Report demonstrates the continued importance of VADs in the treatment of children. With the complexity of cardiac physiologies and sizes of patients, multiple types of devices are used, including paracorporeal continuous, paracorporeal pulsatile, and implantable continuous devices. The preoperative risk factors and differences in patient populations may account for some of the differences in survival observed among these devices. This report, along with other collaborative work, continues to advance the care of this challenging and vulnerable population.
