Schweiger Martin, Hussein Hina, de By Theo M M H, Zimpfer Daniel, Sliwka Joanna, Davies Ben, Miera Oliver, Meyns Bart
Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland.
Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland.
J Cardiovasc Dev Dis. 2023 Aug 17;10(8):351. doi: 10.3390/jcdd10080351.
The withdrawal of HVAD in 2021 created a concern for the pediatric population. The alternative implantable centrifugal blood pump HeartMate 3 has since been used more frequently in children. This paper analyses the outcome of children on LVAD support provided with an HVAD or HM3. A retrospective analysis of the EUROMACS database on children supported with VAD < 19 years of age from 1 January 2009 to 1 December 2021 was conducted. All patients with an LVAD and either an HVAD or HM3 were included. Patients with missing data on VAD status and/or missing baseline and/or follow up information were excluded. Kaplan-Meier survival analysis was performed to evaluate survival differences. Analyses were performed using Fisher's exact test. The study included 150 implantations in 142 patients with 128 implants using an HVAD compared to 28 implants using an HM3. Nine patients (6%) needed temporary right ventricular mechanical support, which was significantly higher in the HM3 group, with 25% (: 0.01). Patients in the HVAD group were significantly younger (12.7 vs. 14.5 years, : 0.01), weighed less (45.7 vs. 60 kg, : <0.000) and had lower BSA values (1.3 vs. 1.6 m, : <0.000). Median support time was 204 days. Overall, 98 patients (69%) were discharged and sent home, while 87% were discharged in group HM3 (: ns). A total of 123 children (86%) survived to transplantation, recovery or are ongoing, without differences between groups. In the HVAD group, 10 patients (8%) died while on support, whereas in 12% of HM3 patients died (: 0.7). Survival in children implanted with an HM3 was excellent. Almost 90% were discharged and sent home on the device.
2021年HVAD的撤出引起了对儿科人群的关注。自那时起，替代性植入式离心血泵HeartMate 3在儿童中使用得更为频繁。本文分析了接受HVAD或HM3支持的左心室辅助装置（LVAD）的儿童的治疗结果。对2009年1月1日至2021年12月1日在欧盟机械循环辅助装置注册系统（EUROMACS）数据库中接受VAD支持的19岁以下儿童进行了回顾性分析。纳入所有植入LVAD且使用HVAD或HM3的患者。排除VAD状态数据缺失和/或基线及随访信息缺失的患者。采用Kaplan-Meier生存分析评估生存差异。分析采用Fisher精确检验。该研究包括142例患者的150次植入，其中128次植入使用HVAD，28次植入使用HM3。9例患者（6%）需要临时右心室机械支持，在HM3组中这一比例显著更高，为25%（P = 0.01）。HVAD组患者显著更年轻（12.7岁对14.5岁，P = 0.01），体重更轻（45.7千克对60千克，P < 0.000），体表面积更低（1.3平方米对1.6平方米，P < 0.000）。中位支持时间为204天。总体而言，98例患者（69%）出院回家，而HM3组出院率为87%（P = 无统计学意义）。共有123名儿童（86%）存活至移植、康复或仍在接受治疗，两组之间无差异。在HVAD组中，10例患者（8%）在接受支持期间死亡，而HM3组患者的死亡率为12%（P = 0.7）。植入HM3的儿童生存率极佳。几乎90%的患者带着该装置出院回家。
