Paracorporeal Support in Pediatric Patients: The Role of the Patient-Device Interaction

Ventricular assist devices are important in the treatment of pediatric heart failure. Although paracorporeal pulsatile (PP) devices have historically been used, there has been increased use of paracorporeal continuous (PC) devices. We sought to compare the outcomes of children supported with a PP or PC, or combination of devices. A retrospective review (2005 to 2019) was made of patients less than 19 years of age from a single center who received a PC, PP, or combination of devices. Patient characteristics were compared between device strategies, and Kaplan-Meier survival analysis was performed. Sixty-six patients were included: 62% male; 62% non-congenital heart disease; median age 0.9 years (interquartile range, 0.2 to 4.9); and median weight 8.5 kg (interquartile range, 4.3 to 17.7 kg). The PC devices were used in 45% of patients, PP in 35%, and a combination in 20%. Patients on PC devices had a lower median weight (P = .02) and a higher proportion of congenital heart disease (P = .02), and more patients required pre-ventricular assist device dialysis (P = .01). There was no difference in pre-ventricular assist device extracorporeal membrane oxygenation use (P = .15). There was a difference in survival among the three device strategies (P = .02). Differences in survival were evident, with patients on PC support having worse outcomes. Transition from PC to a PP devices was associated with a survival advantage. These findings may be driven by differences in patient characteristics across device strategies. Further studies are required to confirm these findings and to better understand the interaction between patient characteristics and device options.