Background

To date, no pediatric studies have highlighted the impact of center’s ventricular assist device (VAD) volumes on post-implant outcomes.

Methods

Children (age <19) enrolled in Pedimacs undergoing initial left ventricular assist device implantation from 2012-2020 were included. Center volume was analyzed as a continuous and categorical variable. For categorical analysis, center volumes were divided as: low volume (1-15 implants), medium volume (15-30 implants) and high volume (>30 implants) during our study period. Patient characteristics and outcomes were compared by center’s VAD volumes.

Results

Of 44 centers, 16 (36.4%) were low, 11 (25%) medium and 17 (38.6%) high volume centers. Children at high volume centers were least likely intubated, sedated, or paralyzed, and most likely ambulating pre-implant (p<0.05 for all). Center’s VAD volumes were not a significant risk factor for mortality post-implant when treated as a continuous or a categorical variable (p>0.05). Compared to low volume, children at high volume centers had fewer early neurological events. Compared to medium volume, those at high volume centers had fewer late bleeding events. (p<0.05 for all). There were no significant differences in survival after an adverse event by hospital volumes (p>0.05).

Conclusion

While hospital volume does not affect post-VAD implant mortality, pediatric centers with higher VAD volumes have fewer patients intubated, sedated, paralyzed pre-implant, and have lower adverse events. Failure to rescue was not significantly different between low, medium, and high-volume VAD centers.

中文翻译：

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中心体积对儿科患者心室辅助装置植入后结局的影响：STS-Pedimacs 数据库分析

背景

迄今为止，还没有儿科研究强调中心心室辅助装置 (VAD) 容量对植入后结果的影响。

方法

纳入 Pedimacs 的儿童（年龄<19）在 2012 年至 2020 年期间接受初始左心室辅助装置植入。中心体积作为连续和分类变量进行分析。对于分类分析，在我们的研究期间，中心体积分为：低体积（1-15 个种植体）、中体积（15-30 个种植体）和高体积（> 30 个种植体）。通过中心的 VAD 容量来比较患者特征和结果。

结果

在 44 个中心中，16 个（36.4%）为低容量中心，11 个（25%）为中等容量中心，17 个（38.6%）为高容量中心。高容量中心的儿童最不可能插管、服用镇静剂或瘫痪，最有可能在植入前行走（所有儿童均 p<0.05）。当被视为连续变量或分类变量时，中心的 VAD 体积并不是植入后死亡率的显着风险因素 (p>0.05)。与低容量中心相比，高容量中心的儿童早期神经系统事件较少。与中等容量中心相比，高容量中心的晚期出血事件较少。（所有p<0.05）。不良事件后的生存率在医院容量方面没有显着差异 (p>0.05)。

结论

虽然医院容量不会影响 VAD 植入后死亡率，但 VAD 容量较高的儿科中心在植入前插管、镇静、瘫痪的患者较少，不良事件也较少。低、中、高容量 VAD 中心的救援失败情况没有显着差异。