The Ninth Annual STS-Pedimacs Report: Pediatric Ventricular Assist Device Outcomes and the Expanding Role of Biventricular Support.

Abstract

This Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) report provides a comprehensive update on pediatric ventricular assist device (VAD) outcomes, including for those requiring biventricular support. Outcomes were analyzed for 1465 patients who underwent VAD implantation from September 19, 2012, to December 31, 2024. Children with congenital heart disease (CHD) undergoing VAD implant continue to increase (28%). For patients with cardiomyopathy, 93% had dilated cardiomyopathy. For those with CHD, 61% had single-ventricle CHD. Implantable continuous VADs were the most commonly implanted devices (508 [35%]). For the overall Pedimacs cohort, survival on device was 77% at 6 months and 73% at 1 year. Survival on the device was greatest among patient ages 11 to 19, those with cardiomyopathy, and those implanted with implantable continuous VADs. Transplant rates and survival were significantly lower for children with single-ventricle CHD compared with cardiomyopathy patients. Successive improvement has occurred in survival among pediatric patients supported on a VAD over time (2012-2015 vs 2016-2020 vs 2021-2024). Patients supported with biventricular devices had a higher preimplant acuity and significantly lower survival than those undergoing only left VAD implantation. This annual Pedimacs report highlights the continued rise in VAD support for children with end-stage heart failure and with improving outcomes. There are significant differences in clinical characteristics and patient outcomes among patients supported with different device types. This report provides a comprehensive analysis of pediatric patients supported with biventricular support.