Outcomes of pediatric patients supported with continuous-flow ventricular assist devices: A report from the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS)

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:35

Article

Rossano, Joseph W.¹  Lorts, Angela²  VanderPluym, Christina J.³  Jeewa, Aamir⁴  Guleserian, Kristine J.⁵  Bleiweis, Mark S.^6,7  Reinhartz, Olaf⁸  Blume, Elizabeth D.³  Rosenthal, David N.⁹  Naftel, David C.¹⁰  Cantor, Ryan S.^10,11  Kirklin, James K.¹⁰ 

[1] Childrens Hosp Philadelphia, Div Cardiol, Cardiac Ctr, 34th St & Civ Ctr Blvd, Philadelphia, PA 19104 USA

[2] Cincinnati Childrens Hosp Med Ctr, Div Cardiol, Inst Heart, Cincinnati, OH 45229 USA

[3] Boston Childrens Hosp, Dept Cardiol, Boston, MA USA

[4] Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA

[5] Univ Texas Southwestern Childrens Med Ctr Dallas, Div Pediat Cardiothorac Surg, Dallas, TX USA

[6] Univ Florida, Dept Surg, Gainesville, FL USA

[7] Univ Florida, Dept Pediat, Gainesville, FL USA

[8] Stanford Univ, Div Pediat Cardiothorac Surg, Palo Alto, CA 94304 USA

[9] Stanford Univ, Dept Pediat, Palo Alto, CA 94304 USA

[10] Univ Alabama Birmingham, Div Cardiothorac Surg, Birmingham, AL USA

[11] Univ Alabama Birmingham, Sch Publ Hlth, Dept Epidemiol, Birmingham, AL 35294 USA

关键词: pediatric;    ventricular assist devices;    mechanical circulatory support;    heart failure;    outcomes;    bridge to transplant;   

DOI  :  10.1016/j.healun.2016.01.1228

来源: Elsevier

【 摘 要 】

BACKGROUND: Continuous-flow (CF) ventricular assist devices (VADs) have largely replaced pulsatile-flow VADs in adult patients. However, there are few data on CF VADs among pediatric patients. In this study we aimed to describe the overall use, patients' characteristics and outcomes of CF VADs in this population. METHODS: The Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) is a national registry for U.S. Food and Drug Adminstration (FDA)-approved VADs in patients <19 years of age. Patients undergoing placement of durable CF VADs between September 2012 and June 2015 were included and outcomes were compared with those of adults from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). RESULTS: CF VADs were implanted in 109 patients at 35 hospitals. The median age at implantation was 15 years (2.8 to 18.9 years) and median weight was 62 kg (range 16 to 141 kg). The underlying disease was cardiomyopathy in 89 (82%) patients. The INTERMACS level at time of implant was Level 1 in 20 (19%), Level 2 in 64 (61%) and Levels 3 to 7 in 21 (20%) patients. Most were implanted as LVADs (n = 102, 94%). Median duration of support was 2.3 months (range <1 day to 28 months). Serious adverse event rates were low, including neurologic dysfunction (early event rate 4.1 per 100 patient-months with 2 late events). Competing outcomes analysis at 6 months post-implant indicated 61% transplanted, 31% alive with device in place and 8% death before transplant. These outcomes compared favorably with the 3,894 adults supported with CF VADs as a bridge to transplant. CONCLUSIONS: CF VADs are commonly utilized in older children and adolescents, with excellent survival rates. Further study is needed to understand impact of patient and device characteristics on outcomes in pediatric patients. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.

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