The Journal of Thoracic and Cardiovascular Surgery
Congenital: Mechanical Circulatory SupportTemporary ventricular assist device support with a catheter-based axial pump: Changing the paradigm at a pediatric heart center
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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Cited by (0)
Institutional Review Board Protocol Number: Approved by the Institutional Review Board of Baylor College of Medicine (H-42811) on October 29, 2018.