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The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): fourth Paediatric EUROMACS
Sofie Rohde1, Joeri van Puyvelde2, Kevin M Veen1
1Department of Cardio-thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Insights
The Paedi-EUROMACS registry shows increasing use of ventricular assist devices (VADs) in children. Congenital heart disease patients had higher mortality and pump thrombosis risk, but VADs are crucial for pediatric mechanical circulatory support.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Congenital Heart Disease
Background:
- Ventricular assist device (VAD) use in children is rising globally.
- Small patient numbers necessitate international collaboration for robust data.
- The Paedi-European Registry for Patients with Mechanical Circulatory Support (EUROMACS) facilitates experience sharing.
Purpose of the Study:
- To present findings from the fourth Paedi-EUROMACS report.
- To analyze outcomes of pediatric VAD implantation.
- To compare outcomes between patients with congenital and non-congenital heart conditions.
Main Methods:
- Included pediatric patients (<19 years) from the EUROMACS database.
- Stratified patients into congenital heart disease (CHD) and non-congenital groups.
- Utilized Cox proportional hazard models to assess mortality, cerebrovascular accident, and pump thrombosis risks.
Main Results:
- 590 primary VAD implants were analyzed.
- Congenital heart disease patients were younger and more likely to receive pulsatile flow devices.
- Higher mortality in the congenital group, but not significant in multivariable analysis; pump thrombosis was common and associated with CHD and pulsatile flow.
Conclusions:
- The fourth Paedi-EUROMACS report confirms the growing application of pediatric VADs.
- Distinct patient characteristics and clinical outcomes exist between congenital and non-congenital etiologies.
- Further research into VAD complications like pump thrombosis is warranted.
Objectives:
The use of ventricular assist devices (VADs) in children is increasing. However, absolute numbers in individual centres and countries remain small. Collaborative efforts such as the Paedi-European Registry for Patients with Mechanical Circulatory Support (EUROMACS) are therefore essential for combining international experience with paediatric VADs. Our goal was to present the results from the fourth Paedi-EUROMACS report.
Methods:
All paediatric (<19 years) patients from the EUROMACS database supported by a VAD were included. Patients were stratified into a congenital heart disease (CHD) group and a group with a non-congenital aetiology. End points included mortality, a transplant and recovery. Cox proportional hazard models were used to explore associated factors for mortality, cerebrovascular accident and pump thrombosis.
Results:
A total of 590 primary implants were included. The congenital group was significantly younger (2.5 vs 8.0 years, respectively, P < 0.001) and was more commonly supported by a pulsatile flow device (73.5% vs 59.9%, P < 0.001). Mortality was significantly higher in the congenital group (30.8% vs 20.4%, P = 0.009) than in the non-congenital group. However, in multivariable analyses, CHD was not significantly associated with mortality [hazard ratio (HR) 1.285; confidence interval (CI) 0.8111-2.036, P = 0.740]. Pump thrombosis was the most frequently reported adverse event (377 events in 132 patients; 0.925 events per patient-year) and was significantly associated with body surface area (HR 0.524, CI 0.333-0.823, P = 0.005), CHD (HR 1.641, CI 1.054-2.555, P = 0.028) and pulsatile flow support (HR 2.345, CI 1.406-3.910, P = 0.001) in multivariable analyses.
Conclusions:
This fourth Paedi-EUROMACS report highlights the increasing use of paediatric VADs. The patient populations with congenital and non-congenital aetiologies exhibit distinct characteristics and clinical outcomes.
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