Use of ICD in Children on VAD Support - An Euromacs Database Analysis

Abstract

<h3>Purpose</h3> Data on the use and outcome of children on VAD support provided with an ICD remains poor. <h3>Methods</h3> A retrospective analysis of the Euromacs database on children supported with VAD < 19ys of age from 1^st January 2009 to 1^st April 2020. Excluded were patients with missing data on status of ICD, missing baseline and/or follow up information. The primary independent variable of interest was the concomitant presence or absence of an ICD at the time of VAD placement. Kaplan Meier survival analysis was performed to evaluate survival differences between children on VAD with and without and ICD. <h3>Results</h3> Out of 303 patients provided with a VAD, 22 (7♀, 15♂) had an ICD implanted and formed the study group. Diagnoses were: CHD (n:5), 16 CMP (n:16), unknow (n:1). Median age 14 ys, median weight 43.5 kg, median BSA 1.39. Median Intermacs stage was 2 (range: 1-7) . Seventeen patients (77%) were transplanted, 4 (18%) died while on support, 1 (5%) was weaned from device after myocardial recovery. Median time on support was 68 days compared to 361 days in the control group. 3 patients underwent device exchange due to thrombus formation in the pump. There was no difference in survival between groups (p=0.342, Chi Quadrant,902). <h3>Conclusion</h3> The presence of ICD in pediatric patients supported with a VAD is low (7%). Children on VAD support provided with an ICD do not have a survival benefit, in contrast to adult with ICD on VAD support.