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

Mary Lynette Stein, Robert Robbins, Arash Alen Sabati, Olaf Reinhartz, Clifford Chin, Esther Liu, Daniel Bernstein, Stephen Roth, Gail Wright, Bruce Reitz, David Rosenthal

Research output: Contribution to journalArticlepeer-review

47 Scopus citations

Abstract

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. Methods and 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. (Circ Heart Fail. 2010;3:682-688.).

Original languageEnglish (US)
Pages (from-to)682-688
Number of pages7
JournalCirculation: Heart Failure
Volume3
Issue number6
DOIs
StatePublished - Nov 2010
Externally publishedYes

Keywords

  • Congenital heart disease
  • INTERMACS
  • Mechanical circulatory support
  • Pediatrics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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