Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)-defined morbidity and mortality associated with pediatric ventricular assist device support at a single US center: the Stanford experience.
BACKGROUND
The use of ventricular assist devices (VADs) to bridge pediatric patients to heart transplantation has increased dramatically over the last 15 years. In this report, we present the largest US single-center report of pediatric VAD use to date. We present detailed descriptions of morbidity and mortality associated with VAD support, using standard Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) criteria for pediatrics to facilitate the comparison of these results to other studies.


RESULTS
We retrospectively identified 25 patients younger than 18 years with 27 episodes of mechanical circulatory support using VADs as bridge to heart transplantation from January 1998 to December 2007. Survival to transplant for the entire cohort was 74%. The most common major morbidities, as defined by INTERMACS criteria for a pediatric population, were respiratory failure, major localized infections, major bleeding events, hepatic dysfunction, and right heart failure. Major neurological events occurred in 48% of the study population. The median time to the first occurrence of an adverse event was less than 14 days for respiratory failure, right heart failure, major localized infection, and major bleeding. Patients who died before transplantation had significantly more adverse events per day of support than did those who were successfully transplanted. Episodes of major bleeding, tamponade, acute renal failure, respiratory failure, and right heart failure were all associated with increased risk of mortality.


CONCLUSIONS
INTERMACS criteria can be successfully used to analyze pediatric VAD outcomes. These data serve as a baseline for future studies of VAD support in children and indicate good survival rates but considerable morbidity.
Stein
Mary Lynette
ML
Stanford University, Stanford, CA 94305, USA.
Robbins
Robert
R
Sabati
Arash Alen
AA
Reinhartz
Olaf
O
Chin
Clifford
C
Liu
Esther
E
Bernstein
Daniel
D
Roth
Stephen
S
Wright
Gail
G
Reitz
Bruce
B
Rosenthal
David
D
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D007373:Interinstitutional Relations; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009017:Morbidity; D009026:Mortality; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies