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Third Annual Pediatric Interagency Registry for Mechanical Circulatory Support (PEDIMACS) Report: Pre-Implant Characteristics and Outcomes

Tuesday, February 26, 2019

Submitted by

Wei-Guo Ma

Source

Source Name: The Annals of Thoracic Surgery

Source URL: https://doi.org/10.1016/j.athoracsur.2019.01.038

Author(s)

David L.S. Morales, Joseph W. Rossano, Christina Vander Pluym, Angela Lorts, Ryan Cantor, James St. Louis, Devin Koeh, David L. Sutcliffe, Iki Adachi, James K. Kirklin, David N. Rosenthal, Elizabeth D. Blume, for the Pedimacs investigators

Today, The Society of Thoracic Surgeons published the third annual Pediatric Interagency Registry for Mechanical Circulatory Support (PEDIMACS) report. Between Sep 19, 2012 and Dec 31, 2017, 423 patients (less than 19 years of age) in 30 hospitals were supported with 508 devices. The etiology was cardiomyopathy in 261 patients (62%), myocarditis in 48 (11%), congenital heart disease (CHD) in 86 (20%, with 52 of these having single ventricle physiology), and other in 28 (7%). The two most common support strategies included left ventricular assist device in 342 patients (81%) and biventricular assist device (BiVAD) in 64 (15%).

At 6 months, 80% of patients were alive on a device or bridged to transplantation/recovery. Patient characteristics and survival were different among three groups of patients supported with three types of pumps:

197 implantable continuous flow pumps: implant age 13.4 ± 3.8 years, 19% INTERMACS profile 1, 21% intubated at implant, 12% with CHD; 92% alive at 6 months
79 paracorporeal continuous flow (PC) pumps: implant age 3.9 ± 5.2 years, 49% INTERMACS profile 1, 86% intubated at implant, 38% with CHD; 66% alive at 6 months
121 paracorporeal pulsatile pumps: implant age 3.3 ± 3.9 years, 41% INTERMACS profile 1, 77% intubated at implant, 21% with CHD; 77% alive at 6 months

Risk factors for early death were INTERMACS profile 1 (hazard ratio, HR 12.6), BiVAD (HR 3.6), percutaneous devices (HR 13.5), PC pumps (HR 4.1), small volume center (HR 3.3), low age (HR 1.01 for age squared), and low weight (HR 0.9). Intubation (functional capacity, HR 4.3) and liver dysfunction (bilirubin in mg/dL, HR 1.1) at the time of implant were constant hazards.

The investigators conclude that implantable continuous flow pumps are the most common type in children, with greater than 90% survival at 6 months, which may represent the maturation in both patient selection and timing of implantation. Currently paracorporeal continuous flow or pulsatile pumps are limited to supporting most challenging patients, those weighing less than 20 kg, and those with congenital heart defects.