Longer-Term Ventricular Assist Devices in Children: 10-Year Retrospective Analysis of Society of Thoracic Surgeons' PEDIMACS.
This retrospective PEDIMACS registry analysis found that 205 of 1,137 children receiving ventricular assist devices remained supported beyond 6 months, with most transplanted by 2 years and prior cancer among several factors associated with mortality.
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This retrospective PEDIMACS registry analysis found that 205 of 1,137 children receiving ventricular assist devices remained supported beyond 6 months, with most transplanted by 2 years and prior cancer among several factors associated with mortality.
Research significance
The evidence shows an association between prior cancer and higher mortality during longer-term pediatric VAD support; it can be hypothesized, but is not demonstrated, that oncology-specific risk stratification and tailored supportive care could improve selection or management of children with cancer histories who require VADs.
Source abstract
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.