Outcomes of pediatric ventricular assist device in the United States: an analysis of the national inpatient sample database

Abstract

Abstract Background Infants and children with advanced heart failure, refractory to medications, are frequently supported with ventricular assist devices (VAD). Purpose To describe the patient characteristics of those who were supported with VADs and describe the factors associated with mortality with use of VAD in the USA. Methods We conducted a retrospective analysis of a large administrative database, the National Inpatient Sample (NIS) dataset for the years 2010 to 2018. We identified pediatric patients (0–18 years of age) who had implantation of VAD during the hospitalization. Patient characteristics and outcomes were compared between survivors and those who died during the hospitalization. Results We identified 1620 patients with VAD procedure in the years we studied. Of them, 324 patients (20%) died during the hospitalization. The trend of utilizing VAD was increasing during the years of the study (Fig. 1). Mortality trend over the study years is presented in figure 2. In multivariable regression analysis, patients with VAD who died were more likely to be less than 1 year of age (OR=4.14, 95% CI:2.29–7.50, p < 0.001), on mechanical ventilation for more than 96 hours (OR=10.71, 95% CI: 6.69–17.14=5, p < 0.001), had liver failure (OR 19.88, 95% CI:10.15-38.95, p<0.001). Those who survived to hospital discharge were more likely to have orthotopic heart transplantation (OR=19.08, 95% CI: 8.12-44.81, p<0.001) and were diagnosed with dilated cardiomyopathy (OR=5.08, 95% CI: 3.38-7.63, p<0.001). Conclusion VAD in pediatric population is increasingly being used in the United States as a bridge to recovery or transplantation. During study period, in hospital mortality trended down significantly. Younger patient's age; less than one year, liver failure and >96 hours mechanical ventilation are considerable risk factors for mortality. Prospective studies are needed to account for confounders, and further classify risk factors based on underlying structural heart disease and clinical status at time of hospital admission.