The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): fourth Paediatric EUROMACS (Paedi-EUROMACS) report

Rohde S. van Puyvelde J. Veen K.M. Schweiger M. Biermann D. Amodeo A. Martens T. Damman K. Gollmann-Tepekoylü C. Hulman M. Iacovoni A. Krämer U.S. Loforte A. Napoleone C.P. Nemec P. Netuka I. Ozbaran M. Polo L. Pya Y. Ramjankhan F. Sandica E. Sliwka J. Stiller B. Kadner A. Franceschini A. Thiruchelvam T. Zimpfer D. Berger F. Davies B. Dashkevich A. Stark C. Meyns B. de By T.M.M.H. Miera O.
1 August 2024 European Association for Cardio-Thoracic Surgery

European Journal of Cardio-thoracic Surgery
2024 #66 Issue 2

OBJECTIVES: The use of ventricular assist devices (VADs) in children is increasing. However, absolute numbers in individual centres and countries remain small. Collaborative efforts such as the Paedi-European Registry for Patients with Mechanical Circulatory Support (EUROMACS) are therefore essential for combining international experience with paediatric VADs. Our goal was to present the results from the fourth Paedi-EUROMACS report. METHODS: All paediatric (<19 years) patients from the EUROMACS database supported by a VAD were included. Patients were stratified into a congenital heart disease (CHD) group and a group with a non-congenital aetiology. End points included mortality, a transplant and recovery. Cox proportional hazard models were used to explore associated factors for mortality, cerebrovascular accident and pump thrombosis. RESULTS: A total of 590 primary implants were included. The congenital group was significantly younger (2.5 vs 8.0 years, respectively, P < 0.001) and was more commonly supported by a pulsatile flow device (73.5% vs 59.9%, P < 0.001). Mortality was significantly higher in the congenital group (30.8% vs 20.4%, P ¼ 0.009) than in the non-congenital group. However, in multivariable analyses, CHD was not significantly associated with mortality [hazard ratio (HR) 1.285; confidence interval (CI) 0.8111–2.036, P ¼ 0.740]. Pump thrombosis was the most frequently reported adverse event (377 events in 132 patients; 0.925 events per patient-year) and was significantly associated with body surface area (HR 0.524, CI 0.333–0.823, P ¼ 0.005), CHD (HR 1.641, CI 1.054–2.555, P ¼ 0.028) and pulsatile flow support (HR 2.345, CI 1.406–3.910, P ¼ 0.001) in multivariable analyses. CONCLUSIONS: This fourth Paedi-EUROMACS report highlights the increasing use of paediatric VADs. The patient populations with congenital and non-congenital aetiologies exhibit distinct characteristics and clinical outcomes.

EUROMACS , Mechanical circulatory support , Paediatric , Transplantation , Ventricular assist device

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Department of Cardio-thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
Department of Congenital Pediatric Surgery, Children’s Hospital Zurich, Zurich, Switzerland
Department of Congenital and Pediatric Heart Surgery, Children’s Heart Clinic, University Heart & Vascular Center Hamburg, Hamburg, Germany
Department of Cardiovascular and Pneumological Sciences, Catholic University of Sacred Heart, Rome, Italy
Department of Cardiovascular and Pneumological Sciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Department of Cardiac Surgery, Ghent University Hospital, Belgium
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
Faculty of Medicine, the Comenius University, Klinika Kardiochirurgie NUSCH, Bratislava, Slovakia
Cardiovascular Department, Ospedale Papa Giovanni XIII, Bergamo, Italy
Division of Pediatric Intensive Care, Department of Pediatric & Neonatal Intensive Care, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
Department of Cardiac Surgery, Sant’Orsola University Hospital, IRCCS Bologna, Bologna, Italy
Department of Surgical Sciences, University of Turin, Turin, Italy
Pediatric and Congenital Cardiac Surgery, Regina Margherita Children’s Hospital, Torino, Italy
Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
Department of Cardiac Surgery and Transplantation Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
Department of Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey
Department of Congenital Cardiac Surgery, La Paz University Hospital, Madrid, Spain
Department of Cardiac Surgery, National Research Cardiac Surgery Center, Astana, Kazakhstan
Department of thoracic surgery, Utrecht University Medical Center, Utrecht, Netherlands
Department of Surgery for Congenital Heart Defects, Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine, Westphalia, Bad Oeynhausen, Germany
Department of Cardiac Surgery, Transplantology and Vascular Surgery, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
Department of Congenital Heart Defects and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
Center for Congenital Heart Disease, Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Division of heart failure, Cardio-Thoracic transplantation and mechanical circulatory support, Bambino Gesu children’s Hospital, Rome, Italy
Heart and Lung Directorate, Great Ormond Street Hospital, London, United Kingdom
Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria
Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Charité - Universitaetsmedizin Berlin, Berlin, Germany
Pediatric Cardiac Surgery Department, Royal Children’s Hospital, Melbourne, Australia
Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
Department of Cardiac Surgery, Helsinki University Hospital, Helsinki, Finland
EUROMACS, EACTS House, Windsor, United Kingdom

Department of Cardio-thoracic Surgery
Department of Cardiac Surgery
Department of Congenital Pediatric Surgery
Department of Congenital and Pediatric Heart Surgery
Department of Cardiovascular and Pneumological Sciences
Department of Cardiovascular and Pneumological Sciences
Department of Cardiac Surgery
Department of Cardiology
Department of Cardiac Surgery
Faculty of Medicine
Cardiovascular Department
Division of Pediatric Intensive Care
Department of Cardiac Surgery
Department of Surgical Sciences
Pediatric and Congenital Cardiac Surgery
Centre of Cardiovascular Surgery and Transplantation
Department of Cardiac Surgery and Transplantation Brno
Department of Cardiovascular Surgery
Department of Cardiovascular Surgery
Department of Congenital Cardiac Surgery
Department of Cardiac Surgery
Department of thoracic surgery
Department of Surgery for Congenital Heart Defects
Department of Cardiac Surgery
Department of Congenital Heart Defects and Pediatric Cardiology
Center for Congenital Heart Disease
Division of heart failure
Heart and Lung Directorate
Department of Cardiac Surgery
Department of Congenital Heart Disease - Pediatric Cardiology
Pediatric Cardiac Surgery Department
Department of Cardiac Surgery
Department of Cardiac Surgery
EUROMACS

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