Fourth Annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report
Fourth Annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report
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DOI：
10.1016/j.athoracsur.2020.09.003
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发表时间：
2020-12-01
影响因子：
4.6
通讯作者：
Rossano, Joseph W.
中科院分区：
文献类型：
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作者：
Morales, David L. S.;Adachi, Iki;Rossano, Joseph W.
背景儿科机构间机械循环支持登记（Pedimacs），最初是美国国立卫生研究院赞助的美国数据库，提供了一个平台，以了解在这个数量不断增加，新设备，扩大适应症和改善结局的时期，心室辅助设备（VAD）支持的儿童人群。在2012年9月19日至2019年12月31日期间，44家医院在856名19岁以下的患者中植入了1031件器械。总体而言，497例（58%）患者的诊断为心肌病，216例（25%）为先天性心脏病（CHD），85例（10%）为心肌炎，58例（7%）为其他。在6个月时，82%的患者发生了积极结局（在器械上存活或桥接至移植和恢复）。植入式连续（IC）泵的患者队列（n = 365）（年龄13.2 ± 3.9岁，18%机械辅助循环支持[Intermacs]概况1的机构间登记研究，23%植入时插管，16%的CHD患者）与旁路连续（PC）泵队列（n = 212）存在显著差异（年龄3.6 +/- 4.9岁，46% Intermacs配置文件1，81%插管，42% CHD）和体外搏动（PP）泵队列（n = 230）（年龄2.7 +/- 3.5岁，31% Intermacs配置文件1，76%插管，26% CHD）。与其队列组成一致，基于器械类型的6个月时的积极结局如下：IC，92%; PC，68%; PP，81%。IC、PC和PP队列中脑血管意外的发生率分别为7%、14%和15%。IC VAD是儿童中最常见的VAD类型，与PP和PC器械相比，其结局改善，尽管PP和PC器械仅限于支持我们最具挑战性的患者。值得注意的是，儿童VAD的脑血管意外发生率显著下降，目前总体为11%。本报告再次证明，尽管通常归因于年龄、尺寸或器械类型，但死亡率和不良事件的大部分负担与VAD植入时患者的总体状态相关。(C)2020年美国胸外科医师协会
Background. The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), originally a National Institutes of Health-sponsored U.S. database, provides a platform to understand the population of children supported with ventricular assist devices (VADs) during this time of increasing numbers, new devices, expanding indications, and improved outcomes.Methods. Between September 19, 2012, and December 31, 2019, 44 hospitals implanted 1031 devices in 856 patients under 19 years of age.Results. Overall, diagnosis was cardiomyopathy in 497 (58%) patients, congenital heart disease (CHD) in 216 (25%), myocarditis in 85 (10%), and other in 58 (7%). Positive outcome (alive on device or bridge to transplantation and recovery) occurred in 82% at 6 months. The patient cohort for implantable continuous (IC) pumps (n = 365) (age 13.2 +/- 3.9 years, 18% Interagency Registry for Mechanically Assisted Circulatory Support [Intermacs] profile 1, 23% intubated at implantation, 16% with CHD) was significantly different from the paracorporeal continuous (PC) pump cohort (n = 212) (age 3.6 +/- 4.9 years, 46% Intermacs profile 1, 81% intubated, 42% CHD) and the paracorporeal pulsatile (PP) pump cohort (n = 230) (age 2.7 +/- 3.5 years, 31% Intermacs profile 1, 76% intubated, 26% CHD). Consistent with their cohort composition, positive outcomes at 6 months based on device type were the following: IC, 92%; PC, 68%; and PP, 81%. The incidence of cerebrovascular accidents in the IC, PC, and PP cohorts was 7%, 14%, and 15%, respectively.Conclusions. IC VADs, the most common VAD type placed in children, are associated with improved outcomes compared with PP and PC devices, though PP and PC devices are limited to supporting our most challenging patients. Noteworthy, the incidence of cerebrovascular accidents for pediatric VADs has significantly decreased and is now 11% overall. This report demonstrates again that although often attributed to age, size, or device type, much of the burden in mortality and adverse events is correlated to the patient's overall state at VAD implantation. (C) 2020 by The Society of Thoracic Surgeons