DOI: 10.1161/jaha.125.044494 ISSN: 2047-9980

Longer‐Term Ventricular Assist Devices in Children: 10‐Year Retrospective Analysis of Society of Thoracic Surgeons’ PEDIMACS

Erika J. Mejia, Devin Koehl, Ryan Cantor, James K. Kirklin, David Morales, Tanya Perry, Katsuhide Maeda, Kimberly Y. Lin, Jonathan Edelson, Matthew O'Connor, Carol Wittlieb‐Weber, Jonathan J. Edwards, Anna Joong, Joseph Rossano
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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.

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