Mechanical circulatory support in pediatric patients with bi- and univentricular hearts

Abstract Objectives Mechanical circulatory support (MCS) in pediatric patients remains challenging due to small body size, limited availability of approved devices and the variety of etiologies, including bi- and univentricular physiologies. We report our single center experience with MCS in pediatric patients in terms of survival and adverse events. Methods Outcome, etiologic and demographic data of pediatric patients implanted with a long-term MCS device between 2011 and 2019 at the Medical University of Vienna were retrospectively collected and analysed. Overall 1-year survival and freedom of treatment related adverse events was investigated by Kaplan Meier analyses and stratified for circulation (bi- vs univentricular), age group (below and above 6 years of age), and pump technology (pulsatile (p-VAD) vs. continuous flow pumps (cf-VAD)). Results One-year survival of all 33 pediatric patients (median [IQR] age: 4 [0 - 13] years) was 73%, with a tendency towards better outcomes in bi- than in univentricular circulations (80% (n=25) vs. 50% (n=8), p=0.063). Trends towards better survival probability in older patients and with cf-VADs did not reach statistical significance (63.2% vs. 85.7%, p=0.165 and 82.4% vs 62.5%, p=0.179, respectively). Freedom from adverse events was higher in older patients (57.1% vs. 5.6%, p Conclusions MCS constitutes a promising therapy for a broad spectrum of pediatric patients, irrespective of heart failure etiology, ages and pump types. With increasing experience, improved devices, and patient selection, MCS may become a valuable treatment option for patients with univentricular hearts.