Section of Congenital Cardiac Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas.
Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
Ann Thorac Surg. 2023 May;115(5):1098-1108. doi: 10.1016/j.athoracsur.2022.10.042. Epub 2022 Nov 17.
The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), supported by The Society of Thoracic Surgeons, provides detailed information on pediatric patients supported with ventricular assist devices (VADs).
From September 19, 2012, to December 31, 2021, there were 1355 devices in 1109 patients (<19 years) from 42 North American Hospitals.
Cardiomyopathy was the most common underlying cause (59%), followed by congenital heart disease (25%) and myocarditis (9%). Regarding device type, implantable continuous (IC) VADs were most common at 40%, followed by paracorporeal pulsatile (PP; 28%) and paracorporeal continuous (PC; 26%). Baseline demographics differed, with the PC cohort being younger, smaller, more complex (ie, congenital heart disease), and sicker at implantation (P < .0001). At 6 months after VAD implantation, a favorable outcome (transplantation, recovery, or alive on device) was achieved in 84% of patients, which was greatest among those on IC VADs (92%) and least for PC VADs (69%). Adverse events were not uncommon, with nongastrointestinal bleeding (incidence of 14%) and neurologic dysfunction (11% [stroke, 4%]), within 2 weeks after implantation being the most prevalent. Stroke and bleeding had negative impacts on overall survival (P = .002 and P < .001, respectively).
This Sixth Pedimacs Report demonstrates the continued evolution of the pediatric field. The complexity of cardiac physiologies and anatomic constraint mandates the need for multiple types of devices used (PC, PP, IC). Detailed analyses of each device type in this report provide valuable information to further advance the care of this challenging and vulnerable population.
儿科机构机械循环支持注册研究（Pedimacs）由胸外科协会支持，提供了接受心室辅助装置（VAD）支持的儿科患者的详细信息。
从 2012 年 9 月 19 日至 2021 年 12 月 31 日，来自 42 家北美医院的 1109 名患者（<19 岁）中有 1355 例设备。
心肌病是最常见的潜在病因（59%），其次是先天性心脏病（25%）和心肌炎（9%）。就装置类型而言，植入式连续（IC）VAD 最为常见（40%），其次是体外搏动（PP；28%）和体外连续（PC；26%）。基线人口统计学数据存在差异，PC 队列更年轻、更小、更复杂（即先天性心脏病），植入时病情更重（P<0.0001）。在 VAD 植入后 6 个月，92%的患者实现了有利的结局（移植、恢复或在设备上存活），其中 IC VAD 患者比例最高（92%），PC VAD 患者比例最低（69%）。不良事件并不少见，植入后 2 周内，非胃肠道出血（发生率为 14%）和神经功能障碍（11%[中风，4%]）最为常见。中风和出血对总生存率有负面影响（P=0.002 和 P<0.001）。
本第六份 Pedimacs 报告展示了儿科领域的持续发展。心脏生理学的复杂性和解剖学限制要求使用多种类型的设备（PC、PP、IC）。本报告中对每种设备类型的详细分析提供了有价值的信息，有助于进一步改善这一具有挑战性和脆弱人群的护理。
