title: Outcomes of pediatric patients supported with continuous-flow ventricular assist devices: A report from the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS).
abstract: Continuous-flow (CF) ventricular assist devices (VADs) have largely replaced pulsatile-flow VADs in adult patients. However, there are few data on CF VADs among pediatric patients. In this study we aimed to describe the overall use, patients' characteristics and outcomes of CF VADs in this population.
  
  
  
  The Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) is a national registry for U.S. Food and Drug Adminstration (FDA)-approved VADs in patients <19 years of age. Patients undergoing placement of durable CF VADs between September 2012 and June 2015 were included and outcomes were compared with those of adults from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS).
  
  
  
  CF VADs were implanted in 109 patients at 35 hospitals. The median age at implantation was 15 years (2.8 to 18.9 years) and median weight was 62 kg (range 16 to 141 kg). The underlying disease was cardiomyopathy in 89 (82%) patients. The INTERMACS level at time of implant was Level 1 in 20 (19%), Level 2 in 64 (61%) and Levels 3 to 7 in 21 (20%) patients. Most were implanted as LVADs (n = 102, 94%). Median duration of support was 2.3 months (range <1 day to 28 months). Serious adverse event rates were low, including neurologic dysfunction (early event rate 4.1 per 100 patient-months with 2 late events). Competing outcomes analysis at 6 months post-implant indicated 61% transplanted, 31% alive with device in place and 8% death before transplant. These outcomes compared favorably with the 3,894 adults supported with CF VADs as a bridge to transplant.
  
  
  
  CF VADs are commonly utilized in older children and adolescents, with excellent survival rates. Further study is needed to understand impact of patient and device characteristics on outcomes in pediatric patients.
authors.affiliation: The Cardiac Center, Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: rossanoj@email.chop.edu.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
authors.affiliation: The Heart Institute, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Angela
authors.initials: A
authors.lastname: Lorts
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Christina J
authors.initials: CJ
authors.lastname: VanderPluym
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Aamir
authors.initials: A
authors.lastname: Jeewa
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, University of Texas Southwestern/Children's Medical Center Dallas, Dallas, Texas.
authors.forename: Kristine J
authors.initials: KJ
authors.lastname: Guleserian
authors.affiliation: Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bleiweis
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Stanford University, Palo Alto, California.
authors.forename: Olaf
authors.initials: O
authors.lastname: Reinhartz
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Blume
authors.affiliation: Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
authors.affiliation: Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: David C
authors.initials: DC
authors.lastname: Naftel
authors.affiliation: Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Cantor
authors.affiliation: Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006333:Heart Failure; D006353:Heart-Assist Devices; D006801:Humans; D011673:Pulsatile Flow; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome
keywords: bridge to transplant; heart failure; mechanical circulatory support; outcomes; pediatric; ventricular assist devices