J Am Coll Cardiol 2011 Sep;58(11):1183-90. [IF:14.292]
Predictors of in-hospital mortality in children after long-term ventricular assist device insertion.
Fan Y , Weng YG , Huebler M , Cowger J , Morales D , Franz N , Xiao YB , Potapov E , Hetzer R .
Department of Cardiovascular Surgery, Chongqing Xinqiao Hospital, Third Military Medical University, Xinqiao Street 1, Chongqing, China. fanye2008728@googlemail.com
重庆第三军医大学新桥医院心血管外科
Abstract
This study aimed to determine the pre-implantation predictors for in-hospital mortality in children with ventricular assist device (VAD) support. Candidate selection is of critical importance for improved outcomes in patients supported with VAD. However, risk factors for post-VAD survival in children are still not clearly understood. From June 1996 to December 2009, 92 children underwent implantation of a long-term VAD at Germany Heart Institute Berlin. Data on all these patients were retrospectively analyzed, and pre-operative risk factors for in-hospital survival after VAD implantation were identified by multivariate logistic regression. Of the 92 subjects, the median age at implantation was 7 years (range 12 days to 18 years), and the median support time was 35 days (range 1 to 591 days). The overall survival rate to transplantation or recovery of ventricular function was 63%. Independent predictors of in-hospital mortality in children included congenital etiology (odds ratio [OR]: 11.2; 95% confidence interval [CI]: 2.6 to 47.5), norepinephrine requirement (OR: 6.9; 95% CI: 1.4 to 31), C-reactive protein level >6.3 mg/dl (OR: 4.9; 95% CI: 1.1 to 22.1), and central venous pressure >17 mm Hg (OR: 4.6; 95% CI: 1.1 to 20). Congenital etiology, pre-operative norepinephrine requirement, higher serum C-reactive protein, and central venous pressure were associated with increased in-hospital mortality in children with VAD support. Optimal candidate selection and timing of VAD insertion may be of great importance for improved outcomes in children with advanced heart failure.
