Short- and long-term survival of children treated with ventricular assist devices in Spain, based on 15 years' experience.

OBJECTIVES: To describe the use of ventricular assist devices (VAD) in children in Spain and to identify variables related to survival. METHODS: This is an observational cohort study of all children younger than 18 years of age who underwent an initial implantation of a VAD at any of the 6 paediatric heart transplant centres from May 2006 to December 2020. Subjects were identified retrospectively from each hospital's database. RESULTS: Paracorporeal VADs were implanted in 118 children [pulsatile (63%), continuous (30.5%) or both types (5.9%)]. Small children (<0.7 m2 of body surface area) comprised the majority of this cohort (63.3%). Overall, 67% survived to VAD explantation, and 64.9% survived to hospital discharge. Non-central nervous system haemorrhage (39%) and stroke (38.1%) were the most common complications. Body weight <5 kg, congenital heart disease, pre-implantation bilirubin >34 µmol/l and bridge to decision strategy were associated with a higher mortality at hospital discharge and in the long-term. Interagency registry for mechanically assisted circulatory support (INTERMACS) status 1 and cardiac arrest prior to VAD implantation were related to long-term mortality, whereas pre-implantation renal replacement therapy and extracorporeal membrane oxygenation were not related to mortality. CONCLUSIONS: In Spain, 67% of the VAD-supported children have been bridged to heart transplantation or to recovery. Body weight lower than 5 kg, congenital heart disease diagnosis, cholestatic liver dysfunction, bridge to decision as VAD strategy, INTERMACS-1 status and cardiac arrest were pre-implantation variables related to mortality, whereas pre-implantation renal replacement therapy and extracorporeal membrane oxygenation were not.

A Venous Malformation: An Unusual Primary Cardiac Tumor in Children.

This case report describes a primary cardiac tumor, classified as venous malformation, diagnosed in an asymptomatic child. The tumor was located in the left atrium near the mitral valve without affecting the mitral valve's functioning. Complete resection of the lesion was performed because of the risk of systemic embolism. The lesion consisted of fibrous tissue with multiple venous vascular channels. The patient did not have similar lesions in other locations. Vascular primary cardiac tumors are extremely rare. Hemangiomas and lymphangiomas have been described previously, but to our knowledge, this is the first primary cardiac tumor identified as a venous malformation.

Perioperative activin A concentrations as a predictive marker of neurologic abnormalities in children after open heart surgery.

BACKGROUND: Ischemic-reperfusion injury of the brain is a major adverse event after cardiac surgery, especially when extracorporeal circuits are used. Because brain injury induces local overproduction of activin A, we measured plasma concentrations in children after open heart surgery with cardiopulmonary bypass (CPB) to investigate the potential of measuring activin A for early identification of infants at risk for brain damage. METHODS: We evaluated 45 infants (age <1 year) with congenital heart defects: 36 without overt neurologic injury, and 9 with neurologic injury on day 7 after the surgical procedure. Blood samples were taken before surgery, during surgery before CPB, at the end of CPB, at the end of surgery, and at 12 h after surgery. Neurologic development was assessed before surgery and on postoperative day 7. RESULTS: Activin A concentrations increased significantly during surgery (P <0.0001) to a maximum at the end of CPB. Infants who developed abnormal neurologic sequelae had concentrations significantly higher (P <0.0001, all comparisons) than patients with normal neurologic outcome at all evaluated times, but not before surgery. Activin A had a sensitivity of 100% (95% CI, 66%-100%) and a specificity of 100% (95% CI, 90%-100%) as a single marker for predicting neurologic abnormalities (area under the ROC curve, 1.0). CONCLUSIONS: Activin A increases in children who experience poor neurologic outcomes after open heart surgery, and its assay may help in early identification of infants at risk for brain damage.