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Published on: June 12, 2021
Longer-Term Ventricular Assist Devices in Children: 10-Year Retrospective Analysis of Society of Thoracic Surgeons'
Erika J Mejia1,2, Devin Koehl3, Ryan Cantor3
1Division of Cardiology, Ann & Robert H. Lurie Children's Hospital Feinberg School of Medicine of Medicine Northwestern University Chicago IL.
Insights
Pediatric ventricular assist device (VAD) use exceeding six months is common, with most children eventually transplanted. However, long-term VAD support presents significant risks and requires further study.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Pediatric Cardiac Surgery
Background:
- Ventricular assist device (VAD) use in children exceeding six months is frequent, yet outcomes data remain limited.
- Understanding long-term VAD support characteristics and adverse events is crucial for pediatric heart failure management.
Purpose of the Study:
- To characterize pre-implant factors, survival rates, and adverse event frequencies in pediatric patients requiring VAD support for over six months.
- To compare outcomes between children supported by VADs for longer-term (>6 months) versus shorter-term (≤6 months) durations.
Main Methods:
- Analysis of pediatric patients (<19 years) who received VADs between September 2012 and March 2022, utilizing the Pediatric Interagency Registry for Mechanical Circulatory Support (PEDIMACS) database.
- Survival analysis was performed, censoring for transplantation or cessation of support, with competing risk analysis for death, transplant, and recovery.
- Patients alive on VAD support at six months were followed up to 24 months and compared to those supported for ≤6 months.
Main Results:
- Of 1137 pediatric patients, 18.0% required VAD support for >6 months. These patients were older and more frequently had cardiomyopathy and implantable continuous devices.
- At two years post-implant, 65% of longer-term VAD patients were transplanted, 9% died, and 20.3% remained on support.
- Mortality risk factors included prior cancer, dialysis, non-implantable continuous devices, and ascites. Common adverse events were infection (27%), device malfunction/pump thrombosis (13.6%), and stroke (4.9%).
Conclusions:
- While most pediatric VAD patients requiring >6 months of support undergo transplantation, a significant portion remains on VAD support at two years.
- Further research is necessary to investigate the morbidity and quality of life associated with long-term VAD support in children.
Background:
One in 5 children with a ventricular assist device (VAD) remains on the device for >6 months. However, there are sparse outcomes data. We sought to characterize preimplant characteristics, survival, and frequency of adverse events.
Methods:
Patients aged <19 years who underwent VAD placement (September 2012-March 2022) and registered in the Society of Thoracic Surgeons' PEDIMACS (Pediatric Interagency Registry for Mechanical Circulatory Support) database were included. Patients alive on VAD support at 6 months were followed up to 24 months and compared with those supported ≤6 months. Survival analyses censored for transplantation or cessation of support. Competing risk analysis was used for death, transplant, and recovery.
Results:
Of 1137 patients, 205 (18.0%) were supported on the device for >6 months. Compared with those supported ≤6 months, those supported >6 months were older (11.2 [5.0-15.2] versus 4.9 [0.6-13.4] years; P<0.001), and had a higher frequency of cardiomyopathy (67.6% versus 59.6%; P=0.029) and implantable continuous devices (68.3% versus 33.6%; P<0.0001). At 2 years from implant, 65% of patients with longer-term use VADs were transplanted, 9% died, and 20.3% were still alive on the device. Mortality risk factors included prior cancer (hazard ratio [HR], 7.77 [95% CI, 2.04-29.55]), dialysis (HR, 3.96 [95% CI, 1.02-15.35]), nonimplantable continuous device (HR, 4.88 [95% CI, 1.45-16.42]), and ascites (HR, 3.86 [95% CI, 1.21-12.34]). Adverse events included infection (27%), device malfunction or pump thrombosis (13.6%), and stroke (4.9%).
Conclusions:
Amongst patients on VAD >6 months, most undergo transplant; however, 20.3% remain on support at 2 years. Further study of morbidity and quality of life is needed.
