Senior Faculty Baylor College of Medicine Baylor College of Medicine BELLAIRE, Texas, United States
Background: Percutaneous ventricular assist devices (pVAD) are seeing increasing use in the support of cardiogenic shock (CS) . Older children and adults with congenital heart disease (CHD) present unique challenges in the use of pVAD support owing to their unique anatomy and physiology.
Methods: Retrospective analysis of patients (age ≥ 16 yo) supported with pVAD over a ten-year period (2015–2024) at TCH. Data was abstracted on demographics, clinical characteristics, indication, type and location of pVAD, complications, duration of support, and outcomes.
Outcome: A total of 26 patients were supported with 31 instances of pVAD use over 10 years. Only 6/26 patients had CHD with the remainder suffering CS as a complication of cardiac transplant (transplant cardiac allograft dysfunction [TCAD]/rejection) or the result of cardiomyopathy or myocarditis. The median and mean age at the time of support was 19 and 23.4 years, respectively (range 16-60 yo). Mean weight was 88.0±25.8 kg, mean height 173.7±9.9 cm with mean BMI 29.0±8.4 kg/m2.The indications for support were transplant cardiac allograft dysfunction (TCAD)/rejection (15 cases), dilated cardiomyopathy (DCM)/myocarditis (4 cases), decompensated heart failure in congenital heart disease (CHD) (6 cases), arrhythmia-related cardiomyopathy (2 cases), and other causes (4 cases).Common complications included arrhythmias, coronary thrombosis and renal failure (all 3 or less cases). Patients were supported using the Impella® CP (13 cases), 5 (5 cases), 5.5 (13 cases) inserted through the femoral (12), axillary (17) and subclavian (2) arteries. Patients were supported for a median of 10 (interquartile range 5-15.5) days. Five patients were simultaneously supported with extracorporeal membrane oxygenation. The reasons for explantation of pVAD included cardiac transplantation (2), recovery (19), LVAD implantation (7), death (1), and device malfunction (2).
Conclusion: Support of CS using pVAD is feasible in selected older pediatric and adult CHD patients with the majority of patients successfully bridged to recovery, durable VAD or transplant. Overall rates of complications and device failure were low.
