Abstract 14935: Beneficial Stroke-Free Survival of Paracorporeal Continuous Flow Support in Children: A Single-Center Experience

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A14935-A14935
• Main Authors: Bishop, Ryan S, Lantz, Jodie L, Baez-Hernandez, Nathanya, Bano, Maria, Butts, Ryan J, Jaquiss, Robert D, Davies, Ryan R, Sutcliffe, David L
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.14935

IntroductionVentricular assist device (VAD) support in small children with end-stage heart failure remains challenging despite improving outcomes. Pulsatile paracorporeal (p-PC) devices have long been the mainstay for support in this group, but continuous flow paracorporeal (cf-PC) devices have increasingly been used. We sought to determine if use of current generation of cf-PC devices would confer beneficial outcomes and adverse event frequency as compared to p-PC use in a heterogeneous pediatric population.MethodsRetrospective review of pediatric patients undergoing durable p-PC or cf-PC implant at a single institution between 3/2006 and 12/2018. Outcomes (explant, transplant, or death) and cumulative adverse event frequency and rates (stroke, device malfunction, and bleeding) were assessed and compared between device types.ResultsParacorporeal VADs were implanted in 32 patients20 p-PC (62.2%) and 12 cf-PC (37.8%, see table). Gender, cardiac diagnoses, and Intermacs profile at implant were not different between groups. cf-PC patients were younger (p = 0.014) and supported for a shorter duration (p = 0.015) than p-PC patients. There was a trend toward improved likelihood of recovery or transplant with cf-PC support (83% vs. 65%, p=0.13). There were no cf-PC stroke events as compared to p-PC patients in whom there was a 35% incidence (p=0.03) and a median time to first stroke of 16 days [12.5, 23.5]. Other adverse events occurred with similar frequency between groups, but the rates of bleeding and pump thrombus/malfunction were higher in the cf-PC group.ConclusionsIn this single institutional series, cf-PC devices provided effective cardiac support with no incidence of stroke over 265 patient-days and positive outcomes in 83% of patients. Bleeding adverse events remain common in small pediatric patients, highlighting the necessity of balancing hemocompatibility risks and anticoagulation decision-making.