Introduction
Ventricular assist device support as a bridge to transplant or recovery is a well-established therapy in children on the cardiac transplantation waiting list. The aim of this study is to investigate incidence and associated factors of cerebrovascular accidents in paediatrics supported by a Berlin Heart EXCOR.
Methods
All patients <19 years of age supported by a Berlin Heart EXCOR between January 2011 and January 2021 from the European Registry for Patients with Mechanical Circulatory Support were included.
Results
In total, 230 patients were included. 140 (60.9%) patients had a diagnosis of dilated cardiomyopathy . 46 patients (20.0%) sustained 55cerebrovascular accidents, with 70.9% of the episodes within 90 days after ventricular assist device implantation. The event rate of cerebrovascular accidents was highest in the first era (0.75). Pump thrombosis and secondary need for right ventricular assist device were found to be associated with cerebrovascular accident (HR 1.998, p = 0.040; HR 11.300, p = 0.037). At 1 year follow-up, 44.4% of the patients had received a transplant, 13.1% were weaned after recovery, and 24.5% had died. Event rates for mortality showed a significantly decreasing trend.
Conclusion
Paediatric ventricular assist device support is associated with important adverse events, especially in the early phase after implantation. Pump thrombosis and the need for secondary right ventricular assist device are associated with cerebrovascular accidents. Furthermore, an encouragingly high rate of recovery in this patient population was shown and death rates declined. A more complete data input of the registry, especially concerning anticoagulation protocols would improve the data.
