부산대학교 도서관

Introduction: Restoring cardiac output and decreasing the impact of heart failure is the goal of ventricular assist device (VAD) therapy. While it is clear that VAD support has a positive impact on survival, it remains unclear what degree of clinical improvement can be seen.Methods: This is a review of the PEDIMACS Registry between 9/19/2012 - 9/30/2016 of patient <19yrs, who received a VAD. Patient demographics and clinical characteristics at implant and follow-up were examined.Results: There were 432 implants, in 364 patients (mean age of 9.3 ± 6.5 yrs; mean weight of 40.6 ± 33.1kg). Primary diagnosis was cardiomyopathy (n=223, 65%) followed by congenital heart disease (n=77, 23%). An LVAD was implanted in 81% and BIVADs in 15%. Pre-implant, 93% required inotropes, 49% were intubated and 51% needed sedation. Over half (55%) required nutritional support and only 29% of eligible patients were ambulatory (Figures A and B). After 3 months of support there were improvements in all clinical areas in those remaining on support (n=137) [74% off inotropes, 93% not intubated; 93% off sedation; (p<0.001)]. Nutritional support was not required in 74% with 78% ambulatory on device support. Clinical changes were accompanied by improvement in the mean BNP (2070 ±166 vs. 429 ± 569, p<0.001). Fifty-five percent of eligible patients were discharged on device, at a median of 29 days post implant (IQR 21- 42).Conclusions: VAD therapy results in improvement in clinical status in pediatric patients, likely leading to better transplant outcomes. Ongoing need for intubation and inotropes may be a marker for right heart failure and requires further analysis to understand the impact of ongoing hemodynamic support.