Mechanical Circulatory Support in Pediatric and Congenital Heart Disease Patients: Evolving Use and Outcome in 325 Patients from the German National Register for Congenital Heart Defects

Objectives: Heart failure is a major contributor to morbidity and mortality in patients with congenital heart disease (CHD). Advanced therapies for heart failure like extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), and ventricular assist devices (VAD) are increasingly used in patients with acquired heart disease. Limited data exists, however, on the use and outcome of these technologies in pediatric and CHD patients.

Methods: Patients receiving therapies with ECMO, IABP, and/or VAD were systematically identified from the German National Register for Congenital Heart Defects. We collected data on patient demographics, underlying cardiac defect, disease complexity, associated conditions, type of procedure, and 30-day mortality in this population.

Results: Overall, 325 patients (mean age: 6.90 ± 11.76 years, 43.4% female, 68.3% with medium or high complexity CHD) underwent a total of 450 interventions (1 intervention n = 303, 2 interventions n = 21, 3 interventions n = 1) during the study period. The most common congenital diagnoses were hypoplastic left heart syndrome (n=43, 13%), and transposition of the great arteries (TGA; n = 24, 7%). The number of procedures increased exponentially during the study period (+342% comparing the period 2010–2014 to 2000–2004). The most common procedure was ECMO (n = 274, 60.9%). Implantation of VAD (n = 117, 26.0%), explantation of VAD (n = 38, 8.4%) and IABP (n = 21, 4.7%) were less common performed. Median age was 0.34 years [IQR: 0.04–3.38] for ECMO, 2.89 years [IQR: 0.37–15.15] for VAD, and 23.07 years [IQR: 17.06–32.79] for IABP. Overall, 30-day mortality rate was 28.1% for patients treated with ECMO, 17.1% for VAD, and 38.1% for IABP. Mean duration of ECMO therapy was 6 days [IQR: 3–12].

Conclusions: The use of advanced treatments for heart failure in pediatric and CHD patients is increasing. Even with these therapies, mortality remains high, reflecting the increasingly complex patient population with heart failure in the context of CHD. The application of these complex treatments to this patient cohort should remain reserved for experienced centers.

No conflict of interest has been declared by the author(s).