Objectives
Analyses of mechanical circulatory support (MCS) in pediatric heart surgery have primarily focused on single-center outcomes or narrow applications. We describe patterns of use, patient characteristics, and MCS-associated outcomes across a large multicenter cohort.
Methods
Patients (<18yrs) in the STS Congenital Heart Surgery Database (2000-2010) were included. Characteristics and outcomes of those receiving post-operative MCS were described, and Bayesian hierarchical models were used to examine variation in adjusted MCS rates across institutions.
Results
Of 96,596 operations (80 centers), MCS was used in 2.4%. MCS patients were younger (13d v. 195d, p<0.0001) and more often had STS-defined preoperative risk factors (57.2% v. 32.7%, p<0.0001). Operations with the highest MCS rates included the Norwood procedure (17%) and complex biventricular repairs (arterial switch/VSD/arch repair-14%). Over half of MCS patients (53.2%) did not survive to hospital discharge (vs. 2.9%, non-MCS patients, p<0.0001). MCS-associated mortality was highest for truncus arteriosus and Ross-Konno operations (both 71%). Hospital-level MCS rates adjusted for patient characteristics and case mix varied by 15-fold across institutions; both high and low volume hospitals had substantial variation in MCS rates.
Conclusion
Perioperative MCS use varies widely across centers. MCS rates are highest overall for the Norwood procedure and complex biventricular repairs. Although MCS can be a life-saving therapy, over half of MCS patients do not survive to hospital discharge with mortality >70% for some operations. Future studies aimed at better understanding appropriate indications, optimal timing, and management of MCS may help to reduce variation in MCS across hospitals and improve outcomes.
MABG in the United States is associated with OM comparable to SABG and increased DSWI risk with BITA-MABG. Our findings highlight the importance of surgeon and institutional experience and careful patient selection for BITA-MABG. Our short-term results should not in any way dissuade the use of MABG, given its well-established long-term survival advantage.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.