Eighth Annual Society of Thoracic Surgeons Pedimacs Report

Abstract

Background: The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), supported by The Society of Thoracic Surgeons, provides detailed information on pediatric patients supported with ventricular assist devices (VADs).

Methods: From September 19, 2012, to December 31, 2023, there were 1648 devices in 1349 patients (aged <19 years) from 39 North American Hospitals, with 100 patients enrolled in 2023.

Results: Cardiomyopathy was the most common underlying etiology (59%), followed by congenital heart disease (26%) and myocarditis (8%). Regarding device type, implantable continuous VADs were most common at 37%, followed by paracorporeal continuous (28%), paracorporeal pulsatile (28%), and percutaneous (7%). Baseline demographics differed, with the paracorporeal continuous cohort being younger, smaller, more complex (ie, congenital heart disease), and sicker at implantation (P < .0001). At 6 months after VAD implantation, a favorable outcome (transplantation, recovery, or alive on device) was achieved in 84% of patients, which was greatest among those on intracorporeal VADs (92%) and least for paracorporeal continuous VADs (71%). Survival for single-ventricle patients is similar to other congenital heart disease patients but inferior to those with cardiomyopathy. Survival for single ventricles varies by stage of palliation.

Conclusions: This Eighth Pedimacs Report demonstrates the important role in VAD support in the care of children with end-stage heart disease. The complexity of cardiac physiologies and anatomic constraint mandates the need for multiple types of devices used. The preimplantation characteristics and different patient populations likely account for some of the differences in outcomes among the different device types.