Percutaneous Impella Device for Mechanical Circulatory Support in Children with Cardiogenic Shock: Long Term Outcomes

Abstract

Use of temporary mechanical circulatory support (MCS) is an alternative to increase systemic blood flow avoiding the possible cardiotoxicity and long-term morbidity of inotropes and vasopressors. It is often the only option to achieve hemodynamic stability. Use of temporary MCS is increasing in frequency in children with evolution of new technologies. Recently, catheter deployed micro-axial percutaneous ventricular assist device (PC-VAD) has been approved for management of cardiogenic shock in adults. We present our experience and long-term outcomes associated with use of this device in a pediatric cardiac intensive care unit at a freestanding children's hospital. All patients treated for cardiogenic shock with PC-VAD alone between September 2014 and June 2019 were included in retrospective analysis. The device sizes used included CP device which provides up to 4.0 l/min of flow and 5.0 device which provides 5.0 l/min of flow. Demographic and support data were reviewed and reported using descriptive statistics. A total of 24 PC-VAD devices were implanted in 18 patients: CP (n=17), and 5.0 (n=7). Median patient age was 17 years (IQR 15,20), weight of 61 kg (IQR 54,75), and BSA of 1.72 m2(IQR 1.58,1.96). Median length of CP support was 5 days (IQR 4,7) and 5.0 was 12 days (IQR 11,22). The most common device related complications included site bleeding 9/24 (38%), ventricular arrhythmias 3/24 (17%) and extremity arterial thrombus 1/24 (4%), with no limb ischemia encountered. Acute renal failure requiring CRRT occurred in 5/18 (38%) patients. None of the patients sustained neurologic injury. Median ICU length of stay was 24 days (IQR 15,45) with median hospital length of stay of 35 days (26,80). The survival to ICU discharge was 89% (16/18) and survival to hospital discharge was 89% (16/18). Twelve out of eighteen (67%) patients were alive at one year. Temporary MCS for cardiogenic shock with PC-VAD shows favorable short and long-term outcomes in select pediatric patients. This type of circulatory support can be considered for management of older children with acute cardiogenic shock to achieve quicker hemodynamic stability, end-organ recovery and as a temporary bridge to recovery or clinical decision making. The risk profile in our population was low and only minor complications occurred during the treatment.