Mechanical circulatory support in pediatric patients with biventricular and univentricular heartsCentral MessagePerspective
Background: Mechanical circulatory support (MCS) in pediatric patients remains challenging because of small body size, limited availability of approved devices, and the variety of etiologies, including biventricular and univentricular physiologies. We report our single-center experience with MCS in...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273621000528 |
| _version_ | 1818744633914556416 |
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| author | Marcus Granegger, PhD Thomas Schlöglhofer, MSc Julia Riebandt, MD Gerald Schlager, MD Keso Skhirtladze-Dworschak, MD Erwin Kitzmüller, MD Ina Michel-Behnke, MD Günther Laufer, MD Daniel Zimpfer, MD |
| author_facet | Marcus Granegger, PhD Thomas Schlöglhofer, MSc Julia Riebandt, MD Gerald Schlager, MD Keso Skhirtladze-Dworschak, MD Erwin Kitzmüller, MD Ina Michel-Behnke, MD Günther Laufer, MD Daniel Zimpfer, MD |
| author_sort | Marcus Granegger, PhD |
| collection | DOAJ |
| description | Background: Mechanical circulatory support (MCS) in pediatric patients remains challenging because of small body size, limited availability of approved devices, and the variety of etiologies, including biventricular and univentricular physiologies. We report our single-center experience with MCS in pediatric patients in terms of survival and adverse events. Methods: Outcome, etiologic, and demographic data of pediatric patients implanted with a long-term MCS device between 2011 and 2019 at the Medical University of Vienna were retrospectively collected and analyzed. Overall survival and freedom of treatment-related adverse events at 1 year were investigated by Kaplan–Meier analyses and stratified for circulation (biventricular vs univentricular), age group (<6 years vs >6 years), and pump technology (pulsatile ventricular assist device [p-VAD] vs continuous flow pump [cf-VAD]). Results: One-year survival of all 33 pediatric patients (median, 4 years; interquartile range, 0-13 years) was 73%, with a tendency toward better outcomes in patients with biventricular circulation than in those with univentricular circulation (80%; n = 25 vs 50%; n = 8; P = .063). The trends toward better survival probability in older patients and in patients with cf-VADs did not reach statistical significance (63.2% vs 85.7%; P = .165 and 82.4% vs 62.5%; P = .179, respectively). Freedom from adverse events was higher in older patients (57.1% vs 5.6%; P < .001) and in the cf-VAD group (52.9% vs 0%; P < .001), with pump thrombosis as the main discriminator. Conclusions: MCS is a promising therapy for a broad spectrum of pediatric patients, irrespective of heart failure etiology, age, and pump type. With increasing experience, improved devices, and patient selection, MCS may become a valuable treatment option for patients with univentricular hearts. |
| first_indexed | 2024-12-18T02:47:25Z |
| format | Article |
| id | doaj.art-894ca201744c4bd89119607a899a203d |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-12-18T02:47:25Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-894ca201744c4bd89119607a899a203d2022-12-21T21:23:32ZengElsevierJTCVS Open2666-27362021-06-016202208Mechanical circulatory support in pediatric patients with biventricular and univentricular heartsCentral MessagePerspectiveMarcus Granegger, PhD0Thomas Schlöglhofer, MSc1Julia Riebandt, MD2Gerald Schlager, MD3Keso Skhirtladze-Dworschak, MD4Erwin Kitzmüller, MD5Ina Michel-Behnke, MD6Günther Laufer, MD7Daniel Zimpfer, MD8Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria; Ludwig–Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Address for reprints: Marcus Granegger, PhD, Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria; Ludwig–Boltzmann Institute for Cardiovascular Research, Vienna, AustriaDepartment of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, AustriaDivision of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Medical University of Vienna, Vienna, AustriaDepartment of Anaesthesia, Intensive Care Medicine, and Pain Medicine, Medical University of Vienna, Vienna, AustriaDivision of Pediatric Cardiology, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, AustriaDivision of Pediatric Cardiology, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, AustriaDepartment of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, AustriaDepartment of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, AustriaBackground: Mechanical circulatory support (MCS) in pediatric patients remains challenging because of small body size, limited availability of approved devices, and the variety of etiologies, including biventricular and univentricular physiologies. We report our single-center experience with MCS in pediatric patients in terms of survival and adverse events. Methods: Outcome, etiologic, and demographic data of pediatric patients implanted with a long-term MCS device between 2011 and 2019 at the Medical University of Vienna were retrospectively collected and analyzed. Overall survival and freedom of treatment-related adverse events at 1 year were investigated by Kaplan–Meier analyses and stratified for circulation (biventricular vs univentricular), age group (<6 years vs >6 years), and pump technology (pulsatile ventricular assist device [p-VAD] vs continuous flow pump [cf-VAD]). Results: One-year survival of all 33 pediatric patients (median, 4 years; interquartile range, 0-13 years) was 73%, with a tendency toward better outcomes in patients with biventricular circulation than in those with univentricular circulation (80%; n = 25 vs 50%; n = 8; P = .063). The trends toward better survival probability in older patients and in patients with cf-VADs did not reach statistical significance (63.2% vs 85.7%; P = .165 and 82.4% vs 62.5%; P = .179, respectively). Freedom from adverse events was higher in older patients (57.1% vs 5.6%; P < .001) and in the cf-VAD group (52.9% vs 0%; P < .001), with pump thrombosis as the main discriminator. Conclusions: MCS is a promising therapy for a broad spectrum of pediatric patients, irrespective of heart failure etiology, age, and pump type. With increasing experience, improved devices, and patient selection, MCS may become a valuable treatment option for patients with univentricular hearts.http://www.sciencedirect.com/science/article/pii/S2666273621000528mechanical circulatory supportsingle ventriclepediatric patientsuniventricular patients |
| spellingShingle | Marcus Granegger, PhD Thomas Schlöglhofer, MSc Julia Riebandt, MD Gerald Schlager, MD Keso Skhirtladze-Dworschak, MD Erwin Kitzmüller, MD Ina Michel-Behnke, MD Günther Laufer, MD Daniel Zimpfer, MD Mechanical circulatory support in pediatric patients with biventricular and univentricular heartsCentral MessagePerspective JTCVS Open mechanical circulatory support single ventricle pediatric patients univentricular patients |
| title | Mechanical circulatory support in pediatric patients with biventricular and univentricular heartsCentral MessagePerspective |
| title_full | Mechanical circulatory support in pediatric patients with biventricular and univentricular heartsCentral MessagePerspective |
| title_fullStr | Mechanical circulatory support in pediatric patients with biventricular and univentricular heartsCentral MessagePerspective |
| title_full_unstemmed | Mechanical circulatory support in pediatric patients with biventricular and univentricular heartsCentral MessagePerspective |
| title_short | Mechanical circulatory support in pediatric patients with biventricular and univentricular heartsCentral MessagePerspective |
| title_sort | mechanical circulatory support in pediatric patients with biventricular and univentricular heartscentral messageperspective |
| topic | mechanical circulatory support single ventricle pediatric patients univentricular patients |
| url | http://www.sciencedirect.com/science/article/pii/S2666273621000528 |
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