Adderley Jeremy, Pidborochynski Tara, Buchholz Holger, Holinski Paula, Anand Vijay, De Villiers Jonker Izak, Freed Darren H, Al-Aklabi Mohammed, Conway Jennifer
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
JTCVS Open. 2024 May 24;20:132-140. doi: 10.1016/j.xjon.2024.05.007. eCollection 2024 Aug.
Pediatric patients on ventricular assist devices (VAD) are at risk of thromboembolic (TE) complications. Our objective was to identify factors associated with TE events, including the role of initial anticoagulation strategy and device type in the pediatric VAD population.
This was a retrospective, single-center review (2005-2022) of children who were implanted with paracorporeal pulsatile (PP), paracorporeal continuous (PC), or a combination of devices. Patient- and device-related factors were collected. Kaplan-Meier survival analysis was performed to determine freedom from TE. Cox proportional hazard analysis was conducted to look for factors associated with TE events.
Ninety-five patients included with a median age of 0.9 years (interquartile range, 0.3, 5.4); median weight of 8.4 kg (interquartile range, 4.5, 17.8), and 63.2% with noncongenital heart disease. Device breakdown included 47.4% PC, 24.2% PP, and 23.2% combination of devices. Initial anticoagulation was either heparin (61.5%) or bivalirudin (38.5%). In Kaplan-Meier analysis, unadjusted freedom from a TE event was significantly greater in those who received bivalirudin as their initial anticoagulation strategy ( = .02) and PP VADs ( = .02). In multivariate analysis, initial anticoagulation strategy with bivalirudin (hazard ratio, 0.30; 95% confidence interval, 0.12-0.75, = .01) was associated with a reduced hazard of TE events, whereas PC device strategy was found to be associated with an increased hazard (hazard ratio, 2.78; 95% confidence interval, 1.12-6.88, = .03).
This study suggests that PC device strategy and heparin as an initial anticoagulation strategy are associated with increased hazard of TE events. Further research is required to understand the interaction between device type and initial anticoagulation strategy.
使用心室辅助装置（VAD）的儿科患者有发生血栓栓塞（TE）并发症的风险。我们的目的是确定与TE事件相关的因素，包括初始抗凝策略和装置类型在儿科VAD人群中的作用。
这是一项对植入体外搏动性（PP）、体外连续性（PC）或联合装置的儿童进行的回顾性单中心研究（2005 - 2022年）。收集了患者和装置相关因素。进行Kaplan - Meier生存分析以确定无TE的情况。进行Cox比例风险分析以寻找与TE事件相关的因素。
纳入95例患者，中位年龄0.9岁（四分位间距，0.3，5.4）；中位体重8.4千克（四分位间距，4.5，17.8），63.2%患有非先天性心脏病。装置类型包括47.4%的PC、24.2%的PP和23.2%的联合装置。初始抗凝药物为肝素（61.5%）或比伐卢定（38.5%）。在Kaplan - Meier分析中，接受比伐卢定作为初始抗凝策略的患者（P = 0.02）和使用PP VAD的患者（P = 0.02）未调整的无TE事件发生率显著更高。在多变量分析中，使用比伐卢定的初始抗凝策略（风险比，0.30；95%置信区间，0.12 - 0.75，P = 0.01）与TE事件风险降低相关，而PC装置策略与风险增加相关（风险比，2.78；95%置信区间，1.12 - 6.88，P = 0.03）。
本研究表明，PC装置策略和肝素作为初始抗凝策略与TE事件风险增加相关。需要进一步研究以了解装置类型与初始抗凝策略之间的相互作用。
