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Waitlist mortality in children with EXCOR support: An analysis of the Japan Excor registry
Takaya Hoashi1, Mariko Asase2,3, Heima Sakaguchi4
1Department of Pediatric Cardiac Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Insights
Ventricular assist device (VAD) therapy with EXCOR paediatric in Japan shows favorable outcomes for bridge-to-transplant. Low weight at implantation is a risk factor for mortality, but overall survival rates are high.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Ventricular assist devices (VADs) are crucial for pediatric heart failure patients awaiting transplantation.
- The EXCOR paediatric system is a widely used VAD for children.
- Understanding outcomes in specific regions like Japan is important for global VAD therapy.
Purpose of the Study:
- To evaluate the prognostic outcomes of EXCOR paediatric VAD therapy in Japan.
- To identify risk factors influencing waitlist mortality in pediatric VAD patients.
Main Methods:
- Retrospective analysis of 137 pediatric patients who received EXCOR paediatric VAD as bridge-to-transplant.
- Data collected from August 2012 to March 2025.
- Evaluation of risk factors including diagnosis, age, weight, and support type.
Main Results:
- The median age was 15.4 months and median weight was 7.2 kg.
- Dilated cardiomyopathy was the most common diagnosis (72.9%).
- One-year survival rate was 92.9%, with 51.0% supported over one year. Weight <5kg was the sole mortality risk factor (HR 2.43).
Conclusions:
- EXCOR paediatric VAD therapy demonstrates favorable prognostic outcomes for bridge-to-transplant in Japan.
- Low body weight at implantation is a significant risk factor for mortality.
- Outcomes are comparable across different primary cardiac diagnoses.
Objectives:
To reveal the prognostic outcomes of ventricular assist device (VAD) therapy with EXCOR paediatric® in Japan.
Methods:
Patients who underwent EXCOR paediatric implantation as a bridging therapy to transplant between August 2012 and March 2025 were enrolled. The following risk factors were evaluated for their potential to influence waitlist mortality: early surgical era, primary diagnosis, age at implantation, weight at implantation, biventricular VAD support, preoperative extracorporeal membrane oxygenation support, and preoperative mechanical ventilator support.
Results:
The total number of 137 patients was identified. The median age and weight at the time of implantation were 15.4 months (interquartile range: 7.3-43.2) and 7.2 kg (5.5-10.9), respectively. The primary diagnosis was dilated cardiomyopathy in 100 patients (72.9%), congenital heart disease in 20 patients (14.6%), and restrictive cardiomyopathy in 8 patients (5.8%). Of those, 70 (51.0%) were supported for a period exceeding one year, and the one-year survival rate was found to be 92.9%. A weight of less than 5 kg at the time of Excor implantation was identified as the sole risk factor for mortality on the waitlist (p = 0.039, Hazard ratio: 2.43, 95% confidence interval: 1.05-5.68). In particular, the mortality rate of patients on the waiting list for congenital heart disease and restrictive cardiomyopathy was comparable to that of patients with dilated cardiomyopathy (p = 0.390, hazard ratio: 1.29, 95% confidence interval: 0.72-2.33).
Conclusions:
An analysis of JEXCOR registry data demonstrated that the prognostic outcome of bridge-to-transplant therapy with Excor paediatric was favorable in Japan.
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