title: Predictors of in-hospital mortality in children after long-term ventricular assist device insertion.
abstract: OBJECTIVE
  This study aimed to determine the pre-implantation predictors for in-hospital mortality in children with ventricular assist device (VAD) support.
  
  
  BACKGROUND
  Candidate selection is of critical importance for improved outcomes in patients supported with VAD. However, risk factors for post-VAD survival in children are still not clearly understood.
  
  
  METHODS
  From June 1996 to December 2009, 92 children underwent implantation of a long-term VAD at Germany Heart Institute Berlin. Data on all these patients were retrospectively analyzed, and pre-operative risk factors for in-hospital survival after VAD implantation were identified by multivariate logistic regression.
  
  
  RESULTS
  Of the 92 subjects, the median age at implantation was 7 years (range 12 days to 18 years), and the median support time was 35 days (range 1 to 591 days). The overall survival rate to transplantation or recovery of ventricular function was 63%. Independent predictors of in-hospital mortality in children included congenital etiology (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 2.6 to 47.5), norepinephrine requirement (OR: 6.9; 95% CI: 1.4 to 31), C-reactive protein level >6.3 mg/dl (OR: 4.9; 95% CI: 1.1 to 22.1), and central venous pressure >17 mm Hg (OR: 4.6; 95% CI: 1.1 to 20).
  
  
  CONCLUSIONS
  Congenital etiology, pre-operative norepinephrine requirement, higher serum C-reactive protein, and central venous pressure were associated with increased in-hospital mortality in children with VAD support. Optimal candidate selection and timing of VAD insertion may be of great importance for improved outcomes in children with advanced heart failure.
authors: Department of Cardiovascular Surgery, Chongqing Xinqiao Hospital, Third Military Medical University, Xinqiao Street 1, Chongqing, China. fanye2008728@googlemail.com
authors: Ye
authors: Y
authors: Fan
authors: Yu-Guo
authors: YG
authors: Weng
authors: Micheal
authors: M
authors: Huebler
authors: Jennifer
authors: J
authors: Cowger
authors: David
authors: D
authors: Morales
authors: Norbert
authors: N
authors: Franz
authors: Ying-Bin
authors: YB
authors: Xiao
authors: Evgenij
authors: E
authors: Potapov
authors: Roland
authors: R
authors: Hetzer
mesh_terms: D000293:Adolescent; D009202:Cardiomyopathies / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000150:complications; D006333:Heart Failure / Q000209:etiology / Q000401:mortality*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors