Mechanical Circulatory Support in Pediatric Myocarditis: Support Strategies and Outcomes in a Nationally Representative Cohort.

Autor:	Kamsheh AM; Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO., Edelson JB; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA., Faerber J; Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA., Mondal A; Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA., Quarshie W; Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA., Edwards JJ; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA., Lin KY; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA., O'Connor MJ; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA., Wittlieb-Weber C; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA., Maeda K; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA., Goldsmith MP; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA., Rossano JW; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA.
Jazyk:	angličtina
Zdroj:	JHLT open [JHLT Open] 2024 Feb; Vol. 3. Date of Electronic Publication: 2023 Nov 23.
DOI:	10.1016/j.jhlto.2023.100026
Abstrakt:	Background: Myocarditis is a common cause of pediatric heart failure which may require mechanical circulatory support (MCS). The purpose of this study is to describe MCS strategies used in a nationwide cohort of pediatric patients with myocarditis, identify trends over time, and compare outcomes between MCS strategies. Methods: This study utilized the Kids' Inpatient Database (KID), a national sample of administrative discharge data. KID admissions from 2003-2016 were queried using ICD-9/10 codes to identify those with a diagnosis of myocarditis. MCS outcomes were compared using logistic regression. Results: Of 5,661 admissions for myocarditis, MCS was used in 424 (7.5%), comprised of extracorporeal membrane oxygenation (ECMO) in 312 (73.6%), including 32 (10.2%) instances of extracorporeal cardiopulmonary resuscitation (ECPR), temporary ventricular assist devices (tVAD) in 28 (6.6%), durable VAD (dVAD) in 42 (9.9%) and combination MCS in 42 (9.9%). MCS use increased over time (p=0.031), but MCS strategies did not significantly change. Mortality was high in the MCS group (28.3%). There was no difference in odds of death in the VAD only or combination MCS group compared to the non-ECPR ECMO group (p=0.07 and p=0.65, respectively). Conclusion: MCS is used in 1 in 13 pediatric myocarditis cases, and MCS use is increasing over time with ECMO remaining the most frequently used modality. Mortality remains high in patients that receive MCS but does not differ between those receiving VAD or combination MCS as compared to non-ECPR ECMO on unadjusted analysis. Further prospective analysis is required to evaluate the relative effectiveness of MCS modalities in this disease.
Databáze:	MEDLINE
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