Continuous Flow Paracorporeal Support in Children: A Single Center Experience

Abstract

<h3>Purpose</h3> Ventricular assist device (VAD) support in small children with end-stage heart failure remains challenging with limited device options. Pulsatile paracorporeal VADs (PP) have long been the mainstay for this group, however outcomes in continuous flow (cf) VADs suggest a beneficial mode of support with consistent physiology between intra- and paracorporeal cfVADs (PC). We sought to describe our center's experience in universal use of PC without transition to PP after the early high risk period. <h3>Methods</h3> We performed a single center retrospective review of all pediatric systemic PC implants from 2017-2021. We evaluated adverse event (AE, ACTION-defined) frequency and rates as well as device outcomes (alive on support, explant, transplant, or death). <h3>Results</h3> Overall 28 PC implants were performed: 24 Pedimag, 4 Centrimag. Patients were predominantly young with median age 0.9 yrs [0.26, 1.74], small with median BSA 0.41 m² [0.29, 0.51], male (65%), with a diagnosis of DCM (11 DCM, 4 Myocarditis, 3 "other" cardiomyopathy, 10 CHD including 6 SV failure), and equally Pedimacs profile 1 and 2 at implant (13-profile 1 and 2, 2-profile 3). Device strategies were bridge to transplant (71%), candidacy (21%), or recovery (7%); and 9 patients (32%) required BiVADs. Median duration of support was 29 days (range 1-544 days). The most frequent AEs were bleeding and infection (both with 9 events, 16.8 per 100 patient-months). Three patients suffered ischemic strokes over the study period (3.75 per 100-pt mo). Outcomes included 1 (3%) alive on support after 544 days and on-going, 5 (18%) explant, 17 (61%) transplant, and 5 (18%) death/compassionate deactivation representing an 82% positive outcome. All deaths were among very high risk patients (SV, <3.5 kg, and biventricular peritransplant failure). <h3>Conclusion</h3> This study represents the largest single center experience of pediatric PC support. Comparisons of PP and PC support to date have largely been from aggregated registry data showing PC support to be inferior, however these data depict PC patients to be composed of higher risk cohorts (congenital heart disease mostly with SV physiology and Pedimacs profile 1). This analysis suggests PC support can provide outcomes similar if not superior to PP support allowing centers to safely support high and low risk patients with consistent cfVAD physiology across the full breadth of the pediatric heart failure spectrum.