Predicting Stroke For Pediatric Patients Supported With Ventricular Assist Devices:A PEDIMACS Report

Abstract

PEDIMACS provides detailed understanding on pediatric patients supported with ventricular assist devices (VADs). We sought to identify important variables affecting the incidence of stroke in pediatric VADs. Between 2012-2022, 1,463 devices in 1,219 patients were reported to PEDIMACS s from 40 Centers in patients<19yrs at their first VAD implantation. Multiphase parametric hazard modeling was used to identify risk factors for stroke among all device types. Of the 1,219 patients, the most common devices were implantable continuous (472 [39%]), followed by paracorporeal pulsatile (342 [28%]), paracorporeal continuous (327 [27%]). Overall freedom from stroke at 6 months was higher in the recent era (2012-2016; 80.2% [77.1%-82.9%] vs 2017-2023; 87.9% [86.2%-89.4%], p=0.009). Implantable Continuous had the highest freedom from stroke at 3 (92.7% [91.1%-93.9%]) and 6 (91.1% [89.3%-92.6%]) months, followed by Paracorporeal Pulsatile (87.0% [84.8%-88.9%] and 82.8% [79.8%-85.5%]), and Paracoporeal Continuous (76.0% [71.8%-79.5%] and 69.5% [63.4%-74.8%]). Parametric modeling identified risk factors for stoke early post implant and later. Overall, and particularly for Paracorporal Pulsatile devices, early stroke risk has decreased in the most recent era (HR 5.01). Among Implantable Continuous devices, cardiogenic shock was the major risk factor. For patients<10kg, early hazard was only seen in previous era. For congentail patients, early hazard was seen in non-implantable device use and use of ECMO. Overall stroke rate has decreased from 20% to 15% at 6 months, with particular improvement among PP devices. Risk factor analyses offer insights for identification of higher stroke risk subsets and further management refinements.