Cerebral strokes in children on intracorporeal ventricular assist devices: analysis of the EUROMACS Registry

Martin Schweiger; Oliver Miera; Theo M M H de By; Michael Hübler; Felix Berger; Mustafa Özbaran; Antonio Loforte; Burkhardt Seifert; Gaetano Gargiulo; Jan Gummert; Paul Mohacsi; EUROMACS members

doi:10.1093/ejcts/ezx342

Cerebral strokes in children on intracorporeal ventricular assist devices: analysis of the EUROMACS Registry

Eur J Cardiothorac Surg. 2018 Feb 1;53(2):416-421. doi: 10.1093/ejcts/ezx342.

Authors

Affiliations

¹ Pediatric Heart Center, Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland.
² Department of Congenital Heart Disease/Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
³ EUROMACS Registry, EACTS, Windsor, UK.
⁴ Ege Üniversitesi Tıp Fakültesi, Kalp Damar Cerrahisi Kliniği, Bornova-İzmir, Türkiye.
⁵ Dipartimento di Chirurgia Cardio-Toraco-Vascolare e Trapianti, Policlinico S. Orsola-Malpighi, Università di Bologna, Bologna, Italy.
⁶ Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
⁷ Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
⁸ Department of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

PMID: 29029180
DOI: 10.1093/ejcts/ezx342

Abstract

Objectives: Little is known about cerebral strokes in paediatric patients supported by intracorporeal continuous-flow ventricular assist devices.

Methods: We retrospectively investigated patients younger than 19 years of age who were treated with an intracorporeal continuous-flow ventricular assist device in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) database. The patients were stratified by body surface area in Group 1 [<1.2 m2 (n = 13)] and Group 2 [≥1.2 m2 (n = 38)]. Cerebral strokes, both ischaemic and haemorrhagic, were studied.

Results: Of the 2941 patients with ventricular assist device (VAD) implants listed in the database, 124 (4%) patients were less than 19 years of age. Fifty-one of them (2%) were supported with a continuous-flow ventricular assist device. Group 1 (6 female and 7 male) had a mean age (±SD) of 9 ± 2.3 years compared with 15.6 ± 1.8 years in Group 2 (21 female and 17 male). Three (23%) patients died in Group 1 on VAD support, whereas 5 (13%) patients died in Group 2 (P = 0.21; log-rank test). Seven (54%) patients with a VAD in Group 1 and 17 (45%) patients in Group 2 underwent transplantation (P = 0.29); of these, 1 (8%) patient recovered (Group 1) with subsequent device explantation. The other patients, 2 in Group 1 and 16 in Group 2, were still on device support at the time of the analysis. There were no cerebral strokes in Group 1, but 4 cerebral strokes (11% of Group 2, 8% of a total of 51 patients in Groups 1 and 2 combined) occurred in Group 2 (3 patients died; P = 0.26; log-rank test). Taken together, the incidence of cerebral strokes in this paediatric cohort of patients with an intracorporeal VAD was 0.1 per patient-year.

Conclusions: The incidence of cerebral strokes in children with intracorporeal VADs (0.1 per patient-year) seems to be low irrespective of the body surface area.

Keywords: Children; Intracorporeal VAD; Neurologic complications; Stroke.

MeSH terms

Adolescent
Body Surface Area
Child
Child, Preschool
Female
Heart Failure / surgery
Heart-Assist Devices* / adverse effects
Heart-Assist Devices* / statistics & numerical data
Humans
Male
Postoperative Complications / epidemiology
Postoperative Complications / mortality
Retrospective Studies
Stroke* / epidemiology
Stroke* / etiology