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Characteristics and Outcomes of Pediatric Patients Supported With Ventricular Assist Device—A Multi-Institutional Analysis*

Puri, Kriti MBBS1; Anders, Marc M. MD2; Tume, Sebastian C. MD2; Cabrera, Antonio G. MD1; Heinle, Jeffrey S. MD3; Causey, Jamie C. MD2; Wang, Yunfei PhD4; Moffett, Brady S. PhD2; Shekerdemian, Lara S. MD2

Pediatric Critical Care Medicine: August 2019 - Volume 20 - Issue 8 - p 744-752
doi: 10.1097/PCC.0000000000001966
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Objectives: The use of ventricular assist devices for pediatric patients with heart failure is increasing, but is associated with significant morbidity and mortality. Our objectives were to describe the admission outcomes and resource utilization of pediatric patients supported with ventricular assist devices, utilizing a multicenter database.

Data Sources: Pediatric Health Information System database (comprising 49 nonprofit children’s hospitals).

Study Selection: Retrospective cohort analysis of the database from January 2006 to September 2015 for all admissions less than or equal to 21 years old with ventricular assist device implantation.

Data Extraction: The primary outcome was hospital mortality. The secondary outcomes were hospital length of stay and adjusted cost.

Data Synthesis: We analyzed 744 ventricular assist device implantations (740 patients), 422 (57%) males, and 363 (49%) non-Hispanic white. Median age at admission was 5.9 years (interquartile range, 0.9–13.5 yr), and median length of stay was 69 days (interquartile range, 36–122 d). The overall hospital mortality was 188 (25%), whereas 395 (53%) were transplanted and 141 (19%) were discharged on ventricular assist device. Extracorporeal membrane oxygenation was used, in addition to ventricular assist device, in 340 (46%). The majority of ventricular assist device implantations (453, 61%) were from 2011 to 2015 (compared to 2006–2010). More patients discharged on ventricular assist device from 2011 to 2015 (23% vs 13% in 2006–2010; p = 0.001). There was no difference in median age, mortality, length of stay, or adjusted costs between these time periods. On multivariable analysis, underlying congenital heart disease, renal failure, liver congestion, sepsis, cerebrovascular accident, and extracorporeal membrane oxygenation were associated with hospital mortality. Sepsis and ventricular assist device replacement/repair were associated with higher adjusted cost and longer length of stay.

Conclusions: The pediatric ventricular assist device experience continues to grow, with a significant increase in the number of patients undergoing ventricular assist device implantation and a higher proportion being discharged from hospital on ventricular assist device support in recent years. Underlying congenital heart disease, renal failure, sepsis, cerebrovascular accident, and extracorporeal membrane oxygenation are significantly associated with hospital mortality.

1Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX.

2Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX.

3Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX.

4Cardiovascular Research Core-Section of Cardiology, Department of Pediatrics, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX.

*See also p. 784.

Dr. Puri carried out the initial analyses, drafted the initial article, and reviewed and revised the article. Dr. Anders conceptualized and designed the study, coordinated data collection, and reviewed and revised the article. Drs. Causey and Moffett coordinated and completed the data collection, and reviewed and revised the article. Dr. Wang supervised the analysis and critically reviewed the article. Drs. Tume, Cabrera, Heinle, and Shekerdemian supervised analysis, and critically reviewed and revised the article. All authors approved the final article as submitted and agree to be accountable for all aspects of the work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Cabrera’s institution received funding from Novartis, and he disclosed off-label product use of continuous flow device use in children. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: kriti.puri@bcm.edu

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies