The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): third Paediatric (Paedi-EUROMACS) report

Abstract

OBJECTIVES A third paediatric report has been generated from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). The purpose of EUROMACS, which is operated by the European Association for Cardio-Thoracic Surgery, is to gather data related to durable mechanical circulatory support for scientific purposes and to publish reports with respect to the course of mechanical circulatory support therapy. Since the first report issued, efforts to increase compliance and participation have been extended. Additionally, the data provided the opportunity to analyse patients of younger age and lower weight. METHODS Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (<19 years of age) performed from 1 January 2000 to 31 December 2020 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events including neurological dysfunction, device malfunction, major infection and bleeding. RESULTS Twenty-five hospitals contributed 537 registered implants in 480 patients. The most frequent aetiology of heart failure was any form of cardiomyopathy (59%), followed by congenital heart disease and myocarditis (15% and 14%, respectively). Competing outcomes analysis revealed that a total of 86% survived to transplant or recovery or are ongoing; at the 2-year follow-up examination, 21.9% died while on support. At 12 months, 45.1% received transplants, 7.5% were weaned from their device and 20.8% died. The 3-month adverse events rate was 1.59 per patient-year for device malfunction including pump exchange, 0.7 for major bleeding, 0.78 for major infection and 0.71 for neurological events. CONCLUSIONS The overall survival rate was 79.2% at 12 months following ventricular assist device implant. The comparison of survival rates of the early and later eras shows no significant difference. A focus on specific subgroups showed that survival was less in patients of younger age (<1 year of age; P = 0.01) and lower weight (<20 kg; P = 0.015). Transplant rates at 6 months continue to be low (33.2%).

Pitfalls and Possibilities of Ventricular Assist Device Support in Congenitally Corrected Transposition of the Great Arteries in Children

“…Only two patients were reported from the registry with ccTGA and overall 10 of 16 were either on support or transplanted at the time of the report. 11,12 Another case report by Tadokoro et al . 8 reported on two adult patients with ccTGA who underwent VAD implant and they employed both preoperative computed tomography (CT) and intraoperative TEE for guidance of inflow cannula placement.…”

“…Only two patients were reported from the registry with ccTGA and overall 10 of 16 were either on support or transplanted at the time of the report. 11,12 Another case report by Tadokoro et al 8 reported on two adult patients with ccTGA who underwent VAD implant and they employed both preoperative computed tomography (CT) and intraoperative TEE for guidance of inflow cannula placement. A review by Riggs et al 13 outlines the representative case reports in largely adult patients with ccTGA requiring VAD (16/19), with the vast majority being successfully transplanted or still on support at the time of their report.…”

Use of implantable cardioverter‐defibrillator in children supported with ventricular assist device: An analysis of data from the EUROMACS registry

“…15 In children, one year after VAD implantation, almost 50% are transplanted and only 26% of children are still on VAD support. 14 This picture is totally different in adults with well over 50% still on device. 15 In this study the median support time in the ICD Group was even shorter, with just around 2 months compared to the control group with almost one year.…”

“…Children on VAD support do have shorter waiting times for cardiac transplantation and the number of children with permanent support is low. In the last pediatric EUROMACS report the percentage of children with the intention of destination therapy was lower than 1% 14 while this percentage in adults was over 20% 15 . In children, one year after VAD implantation, almost 50% are transplanted and only 26% of children are still on VAD support 14 .…”

“…In the last pediatric EUROMACS report the percentage of children with the intention of destination therapy was lower than 1% 14 while this percentage in adults was over 20% 15 . In children, one year after VAD implantation, almost 50% are transplanted and only 26% of children are still on VAD support 14 . This picture is totally different in adults with well over 50% still on device 15 .…”