Pediatric Advance Cardiac Therapies Fellow Lucile Packard Children's Hospital at Stanford University Menlo Park, California, United States
Abstract:
Introduction: Adults supported on a ventricular assist device (VAD) have significant morbidity and mortality after COVID-19. The purpose of this study is to describe the clinical course and outcomes of COVID-19 infection in pediatric patients on VAD.
Methods: We conducted a multicenter retrospective study of pediatric patients supported by VAD through the Advanced Cardiac Therapies Improving Outcomes Network (ACTION). Patients < 22 years old who underwent VAD implantation at an ACTION center between March 2020 – March 2022 were included. We evaluated patient demographics, primary cardiac diagnosis, COVID-19 exposure history, clinical course and outcomes.
Results: A total of 291 patients from 16 centers who underwent VAD placement were included. Of them, 23 (8%) patients had COVID-19 infection confirmed by RT-PCR testing. Among those infected, the median age at VAD implant was 9.8 years (IQR, 4.1–16.2 y), 14 (60.8%) were male and 13 (56.5%) were Non-Hispanic White. The primary diagnoses were cardiomyopathy in 12 (52.2%) and congenital heart disease in 8 (34.8%) patients. Of them, 8 (35%) patients were supported on Berlin Heart EXCOR, 9 (39%) on HeartMate 3, 4 (17%) on HeartWare HVAD, and 2 (9%) on PediMag/CentriMag. The type of support for these patients was LVAD in 19 (82.6%), 1 (4.4%) BIVAD and 3 (13%) with a single ventricle VAD. At the time of diagnosis, 11 (48%) were outpatients (of which 2 [18%] were admitted to a general cardiology floor), 5 (22%) were on a general cardiology floor (of which 1 [20%] required transfer to the ICU), and 6 (26%) were in the cardiac intensive care unit. There were 19 patients (82%) that were symptomatic at the time of diagnosis. The most common presenting symptoms were sore throat (58%), neurological symptoms (47%), cough (32%), fever (32%) and gastrointestinal symptoms (11%). At the time of COVID-19 diagnosis, 1 patient was on mechanical respiratory support, 2 patients were on inotropic support, and 11 patients were on pulmonary vasodilator therapy. Only 3 (13%) patients required escalation of respiratory support. No patient developed MISC. Among the complications within 3 months after COVID-19 diagnosis, there were 2 (9%) patients with ischemic stroke, 3 (13%) required a VAD pump exchange and 2 (9%) had arrhythmias. Only 7 (30%) patients received COVID-19 therapies including remdesivir in 7 patients, dexamethasone in 3, and hydroxychloroquine in 1 patient. At most recent follow-up, 11 (48%) patients have undergone heart transplant (HTx), 1 (4%) had a VAD explant, 2 (9%) are listed for HTx, and 9 (39%) patients are still on VAD support. One patient died secondary to septic shock after HTx, but this was unrelated to COVID-19.
Conclusion: We are reporting the largest case series of COVID-19 infection outcomes among pediatric patients supported on VAD. The majority of infected patients were symptomatic, however few required escalation of care and there was limited morbidity and no mortality due to COVID-19 infection while on VAD support.
