小児VADサポートを受けていた小児の4.5歳時点での最適な神経発達転帰の有病率の評価

The majority of patients who undergo ventricular assist device (VAD) implant in childhood survive to adulthood. This study examined the neurodevelopmental trajectory post VAD and determined factors associated with non-optimal outcome.

Patients implanted with a VAD aged < 6 years between 01/2006 and 12/2020, who underwent assessment at 4.5-7-years of age (and > 6 months post decannulation) with the Complex Pediatric Therapies Follow-up Program were included in a prospective-inception-cohort study. Optimal neurodevelopmental outcome was defined as scores of ≥ 80 on the Wechsler Preschool and Primary Scales of Intelligence, the Beery-Buktenica Developmental Test of Visual-Motor Integration and on the Adaptive Behavior Assessment System, in the absence of cerebral palsy, permanent hearing loss, visual impairment, or seizure disorder. Firth multiple regression analysis was used to determine independent factors associated with non-optimal outcome.

A total of 74 patients underwent VAD implant at age < 6 years with neurodevelopmental assessments available for 48/51 patients who survived to testing. Median age at implant was 0.63 years (IQR 0.20, 2.74), 37.5% were female and 39.6% had congenital heart disease. Optimal outcome occurred in 33% of patients. Optimal outcome was associated with female sex [OR 8.03 (95% CI 1.69-56.64) p = 0.007] and implant between 2015 and 2020 [OR 6.59 (95% CI 1.42-42.62) p = 0.016]. Neurological insult sustained pre-post-VAD [OR 0.10 (95% CI 0.01-0.63) p = 0.01] was associated with a non-optimal outcome.

Optimal outcome was present in one-third of patients. Protective factors were female sex and implant between 2015 and 2020. Neurological insult was associated with a non-optimal outcome.