Stroke in Pediatric Ventricular Assist Device Patients-A PediMACS Registry Analysis. J Heart Lung Transplant 2020 Apr;39(4S):S129-S130
Date
05/30/2020Pubmed ID
32464859DOI
10.1016/j.healun.2020.01.1027Scopus ID
2-s2.0-85085634748 (requires institutional sign-in at Scopus site)Abstract
PURPOSE: To characterize the occurrence of stroke in pediatric patients supported with ventricular assist devices.
METHODS: Analysis of PediMACS database from September 2012 through June 2019. Data specific to stroke are reported. Risk factors associated with stroke were identified using multiphase parametric hazard modeling.
RESULTS: Stroke was observed in 71 (10.7%) of 662 patients. Stroke was more common within the first month following implant (10.1 early vs. 1.7 late per 100 patient months). Freedom from stroke varied by device class (Figure 1). Lower stroke rates were seen in patients with implantable continuous (IC) devices (1.6 IC vs. 6.4 paracorporeal pulsatile (PP) vs. 11.1 paracorporeal continuous per 100 patient months). The most recent era defined as after June 2017 is also associated with lower stroke rates (2.3 recent vs. 3.7 prior to June 2017 per 100 patient months). Time related hazard functioning identified factors associated with stroke amongst the IC and PP subgroups (Table 1). The risk of death increases after stroke (HR 3.4, P<0.001).
CONCLUSION: Stroke remains a concerning complication of pediatric ventricular assist device support. The most recent data is encouraging with improved rates, but survival following stroke continues to be significantly impacted. Continued investigation should focus on early or pre-implant modifiable factors to further impact stroke rates.
