Congenital etiology, norepinephrine need, CRP, central venous pressure predict in-hospital death
WEDNESDAY, Aug. 31 (HealthDay News) -- In children with ventricular assist device (VAD) support, congenital etiology, norepinephrine requirement, C-reactive protein (CRP) levels higher than 6.3 mg/dL, and central venous pressure (CVP) greater than 17 mm Hg are independent predictors of in-hospital mortality, according to a study published in the Sept. 6 issue of the Journal of the American College of Cardiology.
Ye Fan, M.D., from the Third Military Medical University in China, and colleagues examined the pre-implantation predictors for in-hospital mortality in children with VAD support who had end-stage heart failure at the time of VAD insertion. Data collected from 92 children (mean age, 7 years), who underwent implantation of a long-term VAD at the Germany Heart Institute between 1996 and 2009, were included in a multivariate logistic regression analysis. The children had an average VAD support time of 35 days.
The investigators found that the overall survival rate to transplantation or to recovery of ventricular function was 63 percent. Congenital etiology (odds ratio [OR], 11.2), norepinephrine requirement (OR, 6.9), CRP levels higher than 6.3 mg/dL (OR, 4.9), and CVP greater than 17 mm Hg (OR, 4.6) were independent predictors of in-hospital mortality in children.
"The finding of this study suggests that VAD mortality is increased in children with congenital heart disease, pre-operative requirement for norepinephrine, CRP level >6.3 mg/dL, and CVP >17 mm Hg. Appropriate patient selection might be critical to improved outcomes after VAD implantation in children with advanced heart failure," the authors write.
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