Archive | 2021
Mechanical circulatory support in pediatric patients with biventricular and univentricular hearts
Abstract
Abstract Background Mechanical circulatory support (MCS) in pediatric patients remains challenging because of small body size, limited availability of approved devices, and the variety of etiologies, including biventricular and univentricular physiologies. We report our single-center experience with MCS in pediatric patients in terms of survival and adverse events. Methods Outcome, etiologic, and demographic data of pediatric patients implanted with a long-term MCS device between 2011 and 2019 at the Medical University of Vienna were retrospectively collected and analyzed. Overall survival and freedom of treatment-related adverse events at 1\xa0year were investigated by Kaplan–Meier analyses and stratified for circulation (biventricular vs univentricular), age group ( 6\xa0years), and pump technology (pulsatile ventricular assist device [p-VAD] vs continuous flow pump [cf-VAD]). Results One-year survival of all 33 pediatric patients (median, 4\xa0years; interquartile range, 0-13\xa0years) was 73%, with a tendency toward better outcomes in patients with biventricular circulation than in those with univentricular circulation (80%; n\xa0=\xa025 vs 50%; n\xa0=\xa08; P\xa0=\xa0.063). The trends toward better survival probability in older patients and in patients with cf-VADs did not reach statistical significance (63.2% vs 85.7%; P\xa0=\xa0.165 and 82.4% vs 62.5%; P\xa0=\xa0.179, respectively). Freedom from adverse events was higher in older patients (57.1% vs 5.6%; P\xa0 Conclusions MCS is a promising therapy for a broad spectrum of pediatric patients, irrespective of heart failure etiology, age, and pump type. With increasing experience, improved devices, and patient selection, MCS may become a valuable treatment option for patients with univentricular hearts.