Congenital: Mechanical Circulatory Support
Temporary ventricular assist device support with a catheter-based axial pump: Changing the paradigm at a pediatric heart center

Read at the 102nd Annual Meeting of The American Association for Thoracic Surgery, Boston, Massachusetts, May 14-17, 2022.
https://doi.org/10.1016/j.jtcvs.2022.11.039Get rights and content

Abstract

Objective

We report the largest pediatric single-center experience with an Impella (Abiomed Inc) catheter-based axial pump support.

Methods

We conducted a retrospective cohort study of all patients with acute decompensated heart failure or cardiogenic shock requiring catheter-based axial pump support between October 2014 and February 2022. The primary outcome per individual encounter (hospital admission) was defined as bridge-to-recovery, bridge-to-durable ventricular assist device support, bridge-to-cardiac transplantation, or death at 6 months after catheter-based axial pump explantation. Adverse events were defined according to the Pediatric Interagency Registry for Mechanical Circulatory Support criteria.

Results

Our final study cohort included 37 encounters with 43 catheter-based axial pump implantations. A single catheter-based axial pump device was used for support in 33 encounters (89%), with 2 catheter-based axial pump devices used in 3 (8%) separate encounters and 3 catheter-based axial pump devices used in 1 (3%) encounter. The median [range] age, weight, and body surface area at implantation were 16.8 [6.9-42.8] years, 61.1 [23.1-123.8] kg, and 1.7 [0.8-2.5] m2, respectively. The predominant causes of circulatory failure were graft failure/rejection in 16 patients (43%), followed by cardiomyopathy in 7 patients (19%), arrhythmia refractory to medical therapies in 6 patients (16%), myocarditis/endocarditis in 4 patients (11%), and heart failure due to congenital heart disease in 4 patients (11%). Competing outcomes analysis showed a positive outcome with bridge-to-recovery in 58%, bridge-to-durable VAD support in 14%, and bridge-to-cardiac transplantation in 14% at 6 months. Fourteen percent of encounters resulted in death at 6 months.

Conclusions

We demonstrate that catheter-based axial pump support in children results in excellent 1- and 6-month survival with an acceptable adverse event profile.

Section snippets

Study Population

The study was approved by the Institutional Review Board (H-42811) of Baylor College of Medicine. We conducted a retrospective cohort study of all patients with ADHF or CS requiring CBAP support at Texas Children's Hospital between October 2014 and February 2022. The CBAP device used in this cohort was exclusively the Impella, with 3 subtypes: Impella 2.5 (small, up to 2.5 L/min flow), Impella CP (medium, up to 4.0 L/min of flow), and Impella 5.0 or Impella 5.5 (large, up to Impella 5.0 and

Study Population

Our study identified 45 encounters comprising 51 CBAP implantations. We excluded 8 encounters due to concurrent VA-ECMO support. Therefore, our final study cohort included 37 encounters with 43 CBAP implantations (Table E1 includes information on all encounters).

Demographics are summarized in Table 1. In 32 different encounters (86%), a single CBAP device was used; in 4 encounters (11%), 2 CBAP devices were used; and in 1 encounter (3%), 3 devices were deployed. The median [range] age, weight,

Discussion

Our study describes the largest single-institutional pediatric experience of CBAP support for refractory CS and ADHF. The introduction of this novel MCS strategy in the pediatric population, including those with complex CHD, offers an alternative strategy to ECMO, the only other option for temporary MCS available for children. We demonstrate that CBAP support in children results in excellent 1-month survival of 95% and 6-month survival of 88% with an acceptable adverse event profile.

The field

Conclusions

The use of temporary MCS support with a CBAP in pediatric patients with cardiogenic or ADHF shifts the traditional paradigm. Circulatory deteriorating patients can be supported less invasively, promptly, and preceding the development of critical CS than with traditional forms of mechanical support. Short and intermediate outcomes are excellent. The introduction of Impella CPAB devices requires a steep institutional learning curve for optimal patient selection, interventional/surgical approach,

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Institutional Review Board Protocol Number: Approved by the Institutional Review Board of Baylor College of Medicine (H-42811) on October 29, 2018.

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