Cerebrovascular accidents (CVA) are a common problem in pediatric VAD support. This Pedimacs analysis investigates rates, risk factors, and outcomes of CVA in pediatric patients supported on VAD: “Stroke in Pediatric Ventricular Assist Device Patients: A Pediamacs Registry Analysis.” It was published March 12, 2021 in The Journal of Heart and Lung Transplantation.
The researchers conducted an analysis of Pedimacs (September 2012-June 2019) data to determine rates of all neurologic events, specifically CVA. Additionally, a multiphase parametric hazard model was used to determine risk factors, and outcomes of patients with CVA were compared with patients without CVA.
Results You Should Know:
- Out of 662 patients, 87 CVA events occurred in 71 patients (10.7%).
- The paracorporeal pulsatile group had the highest proportion of patients with CVA (16.9%) followed by the paracorporeal continuous group (10.4%); However, the paracorporeal pulsatile group had a lower rate of CVA compared to the paracorporeal continuous group (6.4 vs 11.1 events/100 patient months). This indicates differences in support duration.
- The occurrence of CVA was associated with ascites, higher patient profile groups, and implants within small volume centers.
This study found that CVA continues to be a common complication in pediatric VAD support. The overall percent is now <11%. While late-breaking data is encouraging, CVA is still significantly associated with mortality. We need to focus on pre-implant and early support periods in future efforts.
The lead author of this tremendous work is ACTION leader Rob Niebler of Children’s Hospital of Wisconsin! The other ACTION members and centers involved in this work include Betsy Blume of Boston Children’s Hospital, Angela Lorts of Cincinnati Children’s Hospital Medical Center, David Morales of Cincinnati Children’s Hospital Medical Center, David Rosenthal of Lucile Packard Children’s Hospital, Nancy Ghanayem of Advocate Children’s Hospital, and Shahnawaz Amdani of Cleveland Clinic Children’s.
Niebler RA, Amdani S, Blume B, Cantor RS, Deng L, Kirklin JK, Lorts A, Morales DL, Rosenthal DN, Ghanayem NS. Stroke in pediatric ventricular assist device patients-a pedimacs registry analysis. J Heart Lung Transplant. 2021 Mar 12:S1053-2498(21)02229-4. doi: 10.1016/j.healun.2021.03.008. Epub ahead of print. PMID: 33824064.