Niebler Robert A, Amdani Shahnawaz, Blume Betsy, Cantor Ryan S, Deng Luqin, Kirklin James K, Lorts Angela, Morales David L, Rosenthal David N, Ghanayem Nancy S
Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
Department of Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
J Heart Lung Transplant. 2021 Jul;40(7):662-670. doi: 10.1016/j.healun.2021.03.008. Epub 2021 Mar 12.
Cerebralvascular accidents (CVA) are common complications of pediatric ventricular assist devices (VADs). We employed the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) to investigate rates, risk factors, and outcomes of CVA in pediatric patients supported on VAD.
Analysis of Pedimacs (September 2012-June 2019) data to determine rates of all neurologic events and specifically CVA. Risk factors were determined by a multiphase parametric hazard model. Outcomes of patients with CVA were compared with patients without CVA.
We included 662 patients in our analysis. In total, 87 CVA events occurred in 71 patients (10.7%). The proportion of patients with CVA was highest in the paracorporeal pulsatile group (16.9%) followed by the paracorporeal continuous group (10.4%). However, the rate of CVA was lower in the paracorporeal pulsatile group compared to the paracorporeal continuous group (6.4 vs 11.1 events/100 patient months), which reflects differences in support duration. Ascites, higher patient profile groups, and implants within small volume centers were associated with the occurrence of CVA. Our analysis found that the recent era (i.e., June 2017), and intracorporeal continuous implants were protective. Mortality was higher in patients following a CVA diagnosis compared to those without a CVA diagnosis.
CVA continues to be a problem in pediatric VAD support, though the overall percent is now <11%. Data from the most recent era are encouraging, but CVA is still significantly associated with mortality. Future efforts should focus on pre-implant and early support periods.
脑血管意外（CVA）是小儿心室辅助装置（VAD）常见的并发症。我们利用小儿机械循环支持机构间注册中心（Pedimacs）来调查接受VAD支持的小儿患者发生CVA的发生率、危险因素及预后情况。
分析Pedimacs（2012年9月至2019年6月）的数据，以确定所有神经系统事件尤其是CVA的发生率。通过多阶段参数风险模型确定危险因素。将发生CVA的患者的预后与未发生CVA的患者进行比较。
我们纳入了662例患者进行分析。共有71例患者（10.7%）发生了87次CVA事件。体外搏动性组发生CVA的患者比例最高（16.9%），其次是体外连续性组（10.4%）。然而，体外搏动性组的CVA发生率低于体外连续性组（6.4比11.1次事件/100患者月），这反映了支持持续时间的差异。腹水、较高的患者特征分组以及在小容量中心植入与CVA的发生相关。我们的分析发现，最近时期（即2017年6月）以及体内连续性植入具有保护作用。与未诊断为CVA的患者相比，诊断为CVA的患者死亡率更高。
CVA仍然是小儿VAD支持中的一个问题，尽管目前总体发生率<11%。最近时期的数据令人鼓舞，但CVA仍与死亡率显著相关。未来的工作应集中在植入前和早期支持阶段。
