Angela Lorts1, Pirooz Eghtesady2, Mary Mehegan2, Iki Adachi3, Chet Villa4, Ryan Davies5, Jeffrey G Gossett6, Kirk Kanter7, Juan Alejos8, Devin Koehl9, Ryan S Cantor9, David L S Morales4. 1. The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. Electronic address: angela.lorts@cchmc.org. 2. Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA. 3. Department of Pediatric Cardiothoracic Surgery, Texas Children's Hospital, Houston, Texas, USA. 4. The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 5. Department of Pediatric Cardiothoracic Surgery, Nemours Children's Health System, Wilmington, Delaware, USA. 6. Department of Pediatric Cardiology, UCSF Benioff Children's Hospital, San Francisco, California, USA. 7. Department of Pediatric Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA. 8. Department of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA. 9. Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Abstract
BACKGROUND: Historically, the "temporary" or short-term ventricular assist device (VAD) was used only as a quick bridge to recovery for children with an acute process. In the current era, the devices that were originally used for temporary support are now being used to support children for longer durations and for a variety of indications. In this study we aimed to describe the overall use, patients' characteristics and outcomes of "temporary" VAD use in children. METHODS: The Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) is a National Institutes of Health-supported national registry for United States Food and Drug Administration-approved VADs in patients <19 years of age at the time of VAD implantation (either durable or temporary VAD). Patients undergoing placement of a device classified as a temporary VAD between September 19, 2012 and June 30, 2016 were included. RESULTS: Temporary VADs were implanted in 63 patients at 20 centers, accounting for 19% of all pediatric VAD patients entered into PediMACS. The median age at implantation was 3.7 (range <1 day to 18) years. The underlying diseases were: congenital heart disease in 26 (41%), 20 of whom were classified as single ventricle; cardiomyopathy in 25 (40%); and myocarditis/rejection in 12 (19%). Patients were predominately Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile 1 (51%), and 10 patients (16%) had previously been supported with extracorporeal membrane oxygenation. Median duration of support was 15 (range <1 day to 227) days, with 41 patients (65%) being on support for ≥10 days. The most frequent adverse events were bleeding (29% of patients) and neurologic dysfunction (24% of patients). Overall, 71% (45) achieved a positive outcome (defined as bridge to recovery [30%], transplantation [17%], alive on device [2%] or transition to durable VAD [22%]). Eighty-eight percent (n = 22) of the cardiomyopathy patients and 60% (n = 12) of the single-ventricle patients achieved a favorable outcome. CONCLUSION: Devices historically classified as "temporary" pumps are being used not only as a short-term mechanical circulatory support strategy but also as a longer term support strategy. In this multi-institutional, high-acuity, complex patient cohort, the use of "temporary" VADs resulted in a positive outcome (bridge to transplant, recovery durable device or alive) in 71% of patients.
BACKGROUND: Historically, the "temporary" or short-term ventricular assist device (VAD) was used only as a quick bridge to recovery for children with an acute process. In the current era, the devices that were originally used for temporary support are now being used to support children for longer durations and for a variety of indications. In this study we aimed to describe the overall use, patients' characteristics and outcomes of "temporary" VAD use in children. METHODS: The Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) is a National Institutes of Health-supported national registry for United States Food and Drug Administration-approved VADs in patients <19 years of age at the time of VAD implantation (either durable or temporary VAD). Patients undergoing placement of a device classified as a temporary VAD between September 19, 2012 and June 30, 2016 were included. RESULTS: Temporary VADs were implanted in 63 patients at 20 centers, accounting for 19% of all pediatric VAD patients entered into PediMACS. The median age at implantation was 3.7 (range <1 day to 18) years. The underlying diseases were: congenital heart disease in 26 (41%), 20 of whom were classified as single ventricle; cardiomyopathy in 25 (40%); and myocarditis/rejection in 12 (19%). Patients were predominately Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile 1 (51%), and 10 patients (16%) had previously been supported with extracorporeal membrane oxygenation. Median duration of support was 15 (range <1 day to 227) days, with 41 patients (65%) being on support for ≥10 days. The most frequent adverse events were bleeding (29% of patients) and neurologic dysfunction (24% of patients). Overall, 71% (45) achieved a positive outcome (defined as bridge to recovery [30%], transplantation [17%], alive on device [2%] or transition to durable VAD [22%]). Eighty-eight percent (n = 22) of the cardiomyopathypatients and 60% (n = 12) of the single-ventricle patients achieved a favorable outcome. CONCLUSION: Devices historically classified as "temporary" pumps are being used not only as a short-term mechanical circulatory support strategy but also as a longer term support strategy. In this multi-institutional, high-acuity, complex patient cohort, the use of "temporary" VADs resulted in a positive outcome (bridge to transplant, recovery durable device or alive) in 71% of patients.
Authors: Thomas Palazzolo; Matthew Hirschhorn; Ellen Garven; Steven Day; Randy M Stevens; Joseph Rossano; Vakhtang Tchantchaleishvili; Amy L Throckmorton Journal: Artif Organs Date: 2022-04-14 Impact factor: 2.663
Authors: David M Peng; Devin A Koehl; Ryan S Cantor; Kristen N McMillan; Aliessa P Barnes; Patrick I McConnell; Jessica Jordan; Nicholas D Andersen; James D St Louis; Katsuhide Maeda; James K Kirklin; Steven J Kindel Journal: J Heart Lung Transplant Date: 2018-10-31 Impact factor: 10.247