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Contemporary outcomes of mechanical circulatory support using paracorporeal continuous flow pump in children: A
Jiyong Moon1, Lawrence Greiten2, Christina Vander3
1Division of Cardiovascular and Thoracic Surgery, Dell Children's Medical Center, Austin, Texas.
Insights
Mechanical circulatory support with paracorporeal continuous flow (pCF) pumps in children achieved a 78% positive outcome. Congenital heart disease patients experienced worse outcomes and higher mortality compared to non-CHD patients.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Congenital Heart Disease
Background:
- Mechanical circulatory support (MCS) is crucial for pediatric end-stage heart failure.
- Paracorporeal continuous flow (pCF) pumps are increasingly used in pediatric MCS.
- Evaluating the clinical outcomes of pCF pumps in children is essential.
Purpose of the Study:
- To assess the efficacy and safety of pCF pumps in pediatric patients.
- To compare outcomes between children with and without congenital heart disease (CHD).
- To analyze outcomes based on CHD physiology (single vs. biventricular).
Main Methods:
- Multicenter retrospective study using the ACTION database (April 2018 - July 2023).
- Included children supported with pCF pumps.
- Primary outcome: survival to transplant, explant, or durable device; secondary outcomes: adverse events.
Main Results:
- 367 patients (204 CHD, 163 non-CHD) received pCF support (median 25 days).
- Overall positive outcome was 77.9% (survival/durable device/recovery).
- CHD patients had lower positive outcomes (73.0% vs. 82.2%) and higher mortality (24% vs. 14.1%) compared to non-CHD.
Conclusions:
- pCF pump use in children is associated with a 78% positive outcome in a contemporary cohort.
- Children with CHD demonstrate poorer outcomes and increased mortality with pCF support.
- Outcomes were comparable between single and biventricular CHD, but single ventricles had lower recovery rates.
Background:
This study aims to evaluate the clinical outcomes of mechanical circulatory support (MCS) using paracorporeal continuous flow (pCF) pumps in children.
Methods:
This multicenter retrospective study used the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) database (4/2018-7/2023). Children who were supported with a pCF pump were included. The primary outcome was survival to transplant, explant, or transition to a durable device. The secondary outcomes were adverse events. The outcomes were stratified between non-congenital heart disease (CHD) and CHD with single and biventricular physiology.
Results:
Three hundred and sixty-seven patients (CHD, N = 204, non-CHD, N = 163) were supported with a median of 25 days of support (CHD: 33 vs non-CHD 19 days, p = 0.04). CHD included single ventricle (n = 135 [66.2%]) and biventricular physiology (n = 69 [33.8%]). Non-CHD included dilated cardiomyopathy (n = 130 [79.8%]), transplant graft dysfunction (n = 9 [5.5%]), and others (n = 18 [11%]). Patients with CHD were younger (0.55 vs 2.0 years, p ≤ 0.001) and smaller (body surface area 0.35 vs 0.52 m2, p ≤ 0.001, weight 6.7 vs 11.1 kg, p ≤ 0.001) than those without CHD. Overall positive outcome was 77.9% (n = 286) [survival to transplant: 38.7% (n = 142), durable device: 22.9% (n = 84)], recovery: 16.3% (n = 60). Between CHD and non-CHD, CHD showed lower positive outcomes (73.0 vs 82.2%, p = 0.05) with higher mortality (24 vs 14.1%, p = 0.02). There were comparable positive outcomes between single and biventricular CHD (73.0%), with a lower recovery rate in single ventricles (8.9% vs 21.8%, p = 0.01).
Conclusion:
Mechanical circulatory support using a pCF pump in children was associated with a positive outcome in 78% of patients in a contemporary cohort. However, patients with CHD patients fared worse than patients without CHD.
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