From the Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
The Johns Hopkins Hospital, Baltimore, Maryland.
ASAIO J. 2022 Jan 1;68(1):87-95. doi: 10.1097/MAT.0000000000001420.
While clinical status at the time of ventricular assist device (VAD) implant can negatively affect outcomes, it is unclear if early improvement after implant can have a positive effect. Therefore, the objectives of this study were to describe the clinical status of pediatric patients supported with a VAD and determine the impact of clinical status on the 1-month follow-up form on survival and ability to discharge. This was a retrospective analysis of data collected prospectively by the Pediatric Interagency Registry for Mechanical Circulatory Support Registry (Pedimacs) Registry. The Pedimacs database was queried for patients implanted between September 19, 2012, and September 30, 2019, who were alive on VAD support at 1-month postimplant on either a paracorporeal pulsatile or intracorporeal continuous device. Four factors on the 1-month follow-up were the focus of this study: mechanical ventilation, supplemental nutritional support, inotropic support, and ambulatory status. These factors were regarded as present if detected between 1-week and 1-month postimplant and were analyzed to determine their impact on survival following 1 month of VAD support and on successful discharge from hospital in patients with implantable continuous-flow devices. The eligible study cohort consisted of 414 patients with a mean age of 9.6 ± 6.2 years, weight of 40.8 ± 32.3 kg with the majority being male (56.7%) and having cardiomyopathy (68%). An isolated left ventricular assist device (LVAD) was the most common implant (85.5%). At implant, 40% were ventilated, 57% required nutritional support, 93% were on inotropes, and 58% were nonambulating. On the 1-month postimplant form, there were significant improvements in all four categories (14% ventilator support, 46% nutritional support, 53% on inotropes, and 25% nonambulating). However, there was no significant early change in the percentage of patients requiring supplemental nutrition in the paracorporeal pulsatile devices (88% vs. 82%; p = 0.2). Presence of these clinical parameters in early follow-up postimplant had a significant negative impact on survival and on the ability of patients with continuous-flow devices to be discharged. Presence of four specific clinical parameters early after VAD placement is associated with worse overall survival and an inability to discharge patients on VAD support. Ongoing work is needed for optimization of patients before implant and aggressive rehabilitation after implant to help improve long-term outcomes.
虽然心室辅助装置（VAD）植入时的临床状况可能会对结果产生负面影响，但目前尚不清楚植入后早期的改善是否会产生积极影响。因此，本研究的目的是描述接受 VAD 治疗的儿科患者的临床状况，并确定临床状况对植入后 1 个月随访表中生存率和出院能力的影响。这是对儿科机械循环支持登记处（Pedimacs）登记处前瞻性收集的数据进行的回顾性分析。在植入日期为 2012 年 9 月 19 日至 2019 年 9 月 30 日之间、植入后 1 个月仍存活并使用体外搏动或体内连续 VAD 支持的患者中，查询了 Pedimacs 数据库。本研究关注的是植入后 1 个月随访表中的 4 个因素：机械通气、补充营养支持、正性肌力支持和活动能力。如果在植入后 1 周到 1 个月之间检测到这些因素，则认为存在这些因素，并分析其对植入后 1 个月 VAD 支持后的生存率以及对植入连续流设备的患者成功出院的影响。合格的研究队列包括 414 名患者，平均年龄为 9.6 ± 6.2 岁，体重为 40.8 ± 32.3kg，其中大多数为男性（56.7%），患有心肌病（68%）。最常见的植入物是单独的左心室辅助装置（LVAD）（85.5%）。植入时，40%的患者需要通气，57%需要营养支持，93%需要正性肌力药物，58%的患者不能活动。在植入后 1 个月的随访表上，所有四个类别都有显著改善（14%的呼吸机支持，46%的营养支持，53%的正性肌力支持，25%的非活动能力）。然而，体外搏动装置中需要补充营养的患者比例在早期没有显著变化（88%对 82%；p = 0.2）。植入后早期出现这些临床参数对生存率和连续流设备患者的出院能力有显著的负面影响。VAD 植入后早期出现四个特定的临床参数与总体生存率下降和 VAD 支持下患者无法出院有关。需要进一步开展工作，优化患者在植入前的状况，并在植入后进行积极的康复治疗，以帮助改善长期结果。
