Second annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) report: Pre-implant characteristics and outcomes
Second annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) report: Pre-implant characteristics and outcomes
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DOI：
10.1016/j.healun.2017.06.017
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发表时间：
2018-01-01
影响因子：
8.9
通讯作者：
Rosenthal, DavidN.
中科院分区：
文献类型：
--
作者：
Blume, Elizabeth D.;VanderPluym, Christina;Rosenthal, DavidN.
背景：小儿心室辅助装置（VAD）的广泛使用降低了等待心脏移植儿童的死亡率。儿科机构间登记的机械循环支持（Pedimacs），国家心脏，肺，血液研究所赞助的北美数据库，提供了一个平台，以了解这一新兴population.METHODS：在2012年9月至2016年9月，年龄小于19岁的患者接受VAD植入入组Pedimacs。包括FDA批准的耐用器械以及临时支持器械。第二份年度报告更新了目前的Pedimacs数据。Pedimacs中包括植入临时设备的患者，该分析包括这组旁连续流VADs.Results：在4年中，42家医院在364名19岁以下的患者中植入了432个设备。诊断包括心肌病223例（61%），心肌炎41例（11%），先天性心脏病77例（21%），其中48例为单心室生理学。植入时，87%的患者处于Intermacs患者特征1或2。接受VAD支持的儿童（59%为男性）的年龄分布包括69名（19%）1岁以下儿童、66名（18%）1至6岁儿童、56名（15%）6至10岁儿童和173名（48%）11至19岁儿童。中位随访时间为2.2个月（范围：1天至41.5个月）。植入时的中位（四分位数）年龄为1.7（0.3-10.0）岁（n = 60），1.7（0.4-5.3）岁（n = 105），15.0（11.3-16.9）岁（n = 174）。支持策略包括LVAD 293例（80%），双心室装置55例（15%），全人工心脏8例（2%）。近50%的患者在6个月内接受了移植，总死亡率为19%。不良事件负担仍然很高。结论：Pedimacs构成了最大的纵向儿科VAD注册。各中心的植入前数据将有助于创建共享方案，以改善结局。不良事件仍然是主要的挑战，特别是在患有复杂先天性疾病的危重患儿中。(C)2018年国际心肺移植学会。All rights reserved.
BACKGROUND: Expanded use of pediatric ventricular assist devices (VADs) has decreased mortality in children awaiting heart transplantation. Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), a National Heart, Lung, and Blood Institute sponsored North American database, provides a platform to understand this emerging population.METHODS: Between September 2012 and September 2016, patients aged younger than 19 years who underwent VAD implantation were enrolled in Pedimacs. FDA approved durable devices as well as temporary support devices were included. The second annual report updates the current Pedimacs data. Patients implanted with temporary devices are included in Pedimacs and this analysis includes this group of paracorporeal continuous flow VADs.RESULTS: Over the 4 years, 42 hospitals implanted 432 devices in 364 patients less than 19 yrs of age. Diagnoses included cardiomyopathy in 223 (61%), myocarditis in 41 (11%), and congenital heart disease in 77 (21%), of which 48 had single-ventricle physiology. At implant, 87% were at Intermacs patient profile 1 or 2. The age distribution of children (59% male) supported on VAD included 69 (19%) aged younger than 1 year, 66 (18%) aged 1 to 6 years, 56 (15%) aged 6 to 10 years, and 173 (48%) aged 11 to 19 years. Median follow-up was 2.2 months (range, 1 day to 41.5 months). Median (interquartile) age at implant was 1.7 (0.3-10.0) years for paracorporeal continuous-flow pumps (n = 60), 1.7 (0.4-5.3) years for paracorporeal pulsatile pumps (n = 105), and 15.0 (11.3-16.9) years for implantable continuous-flow pumps (n = 174). Support strategies included LVAD in 293 (80%), biventricular device in 55 (15%), and total artificial heart in 8 (2%). Nearly 50% of patients underwent transplantation within 6 months, with overall mortality of 19%. Adverse event burden continues to be high.CONCLUSIONS: Pedimacs constitutes the largest longitudinal pediatric VAD registry. Preimplant data across centers will be helpful at creating shared protocols with which to improve outcomes. Adverse events continue to be the major challenge, especially among the young critically ill children with complex congenital disease. (C) 2018 International Society for the Heart and Lung Transplantation. All rights reserved.