BACKGROUND The use of ventricular assist device (VAD) in children has increased, but the decision of left VAD (LVAD) vs biventricular support remains a challenge. Children who undergo LVAD placement are at risk for right ventricular failure (RHF), but the incidence has not been described. METHODS Analysis was performed for patients <18 years old who underwent durable LVAD placement within the Pedimacs registry (September 19, 2012-February 28, 2017), excluding single ventricle morphology and temporary devices. RHF was defined as the need for right ventriculalr assist device (RVAD) or prolonged inotrope use between 1 week to 1 month and 1 to 3 months. End-points included death, heart transplant (HT), and recovery. RESULTS A total of 272 durable LVAD were placed of which 37 died on device over 24 month follow-up, primarily from multiorgan failure and neurologic dysfunction. RVAD occurred in 12 children at median 8.5 days, with 9 undergoing HT and 3 dying on device. In patients with only LVAD, RHF was present in 111/207 (55%) between 1 week to 1 month and 28/116 (25%) between 1 and 3 months. Younger age, smaller weight, Intermacs profile 1, chemical paralysis, and pulsatile flow VAD were associated with RHF. RHF was associated with increased risk of death on device at both >1 month (hazard ratio 3.2, 95% CI 1.4-7.7, p = 0.007) and >3 month (hazard ratio 6.9, 95% CI 2-23.1, p = 0.002). CONCLUSIONS In children, RHF is common after durable LVAD implantation, but subsequent RVAD is relatively rare. RHF in children, as indicated by prolonged inotrope support, was associated with an increased risk of death on the device. Whether early RVAD support and higher waitlist status may improve the outcome remains unknown.

中文翻译：

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儿童左心辅助装置植入术导致的右心衰竭：Pedimacs注册数据库的分析。

背景技术在儿童中使用心室辅助装置（VAD）的情况有所增加，但是左VAD（LVAD）与双心室支持的决定仍然是一个挑战。接受LVAD放置的儿童有发生右心衰竭（RHF）的风险，但尚未描述其发生率。方法对在Pedimacs注册表中（2012年9月19日至2017年2月28日）接受LVAD持久放置的<18岁患者进行分析，不包括单心室形态和临时装置。RHF被定义为需要右心室辅助装置（RVAD）或在1周至1个月至1-3个月之间长期使用Introtrope。终点包括死亡，心脏移植（HT）和恢复。结果总共放置了272例持久性LVAD，其中24个月的随访中有37例在设备上死亡，主要来自多器官衰竭和神经功能障碍。RVAD发生于中位8.5天的12例儿童中，其中9例接受了HT，3例在设备上死亡。在只有LVAD的患者中，在1周至1个月之间，RHF出现在111/207（55％），在1至3个月之间，出现在28/116（25％）。年龄较小，体重较轻，Intermacs轮廓1，化学性瘫痪和搏动性VAD与RHF相关。RHF与> 1个月（危险比3.2，95％CI 1.4-7.7，p = 0.007）和> 3个月（危险比6.9，95％CI 2-23.1，p = 0.002）的设备死亡风险增加相关）。结论在儿童中，RHF在持久性LVAD植入后很常见，但随后的RVAD相对较少。长期的药物治疗支持表明，儿童的RHF与设备死亡风险增加有关。