Abstract 21330: Predictors of Mortality After a Long-Term Ventricular Assist Device Insertion in Children With Advanced Heart Failure
Background: Patient selection is of critical importance for improved survival in patients supported with ventricular assist devices (VADs). Although numerous predictors and risk scores have been reported based on adult recipients, the risk factors for survival in pediatric VAD patients have not been well defined.
Methods: From 1996 Jun to 2009 Dec, 92 children (48 males) were implanted with a long-term ventricular assist device at our Institute. Preoperative clinical, echocardiographic, hemodynamic, and laboratory data were retrospectively reviewed to determine factors associated with postimplantation mortality. Independent predictors identified by multivariate logistic regression were further used to establish a risk score to predict survival in children after VAD insertion.
Results: The etiology of end-stage heart failure included non-congenital in 71 children (77%) and congenital heart disease in 21 (23%). The overall survival rate to transplantation, recovery of ventricular function, or ongoing device support was 64.1%. Independent predictors of post-VAD mortality in children included congenital etiology, C-reactive protein > 6.0 mg/L, preoperative use of norepinene, and central venous pressure > 17 mmHg. Based on the regression coefficients of multivariate analysis, the score was developed: (congenital etiology × 7) + (C-reactive protein > 6.0 mg/L × 5) + (preoperative use of norepinene × 4) + (central venous pressure > 17 mmHg × 3). Children with a score > 5 have significantly higher mortality compared to those with score ≤ 5 (P < 0.001). Area under the receiver-operating characteristic curve for the score was 0.81, which was superior to that of previously published predictors and risk scores developed based on adult or adolescent patients.
Conclusions: The risk score may be useful to predict post-VAD survival in pediatric patients, and select those who might mostly benefit from VAD insertion.
- © 2010 by American Heart Association, Inc.