OBJECTIVES: The use of ventricular assist devices (VADs) in children is increasing. However, absolute numbers in individual centres and countries remain small. Collaborative efforts such as the Paedi-European Registry for Patients with Mechanical Circulatory Support (EUROMACS) are therefore essential for combining international experience with paediatric VADs. Our goal was to present the results from the fourth Paedi-EUROMACS report. METHODS: All paediatric (<19 years) patients from the EUROMACS database supported by a VAD were included. Patients were stratified into a congenital heart disease (CHD) group and a group with a non-congenital aetiology. End points included mortality, a transplant and recovery. Cox proportional hazard models were used to explore associated factors for mortality, cerebrovascular accident and pump thrombosis. RESULTS: A total of 590 primary implants were included. The congenital group was significantly younger (2.5 vs 8.0 years, respectively, P < 0.001) and was more commonly supported by a pulsatile flow device (73.5% vs 59.9%, P < 0.001). Mortality was significantly higher in the congenital group (30.8% vs 20.4%, P = 0.009) than in the non-congenital group. However, in multivariable analyses, CHD was not significantly associated with mortality [hazard ratio (HR) 1.285; confidence interval (CI) 0.8111-2.036, P = 0.740]. Pump thrombosis was the most frequently reported adverse event (377 events in 132 patients; 0.925 events per patient-year) and was significantly associated with body surface area (HR 0.524, CI 0.333-0.823, P = 0.005), CHD (HR 1.641, CI 1.054-2.555, P = 0.028) and pulsatile flow support (HR 2.345, CI 1.406-3.910, P = 0.001) in multivariable analyses. CONCLUSIONS: This fourth Paedi-EUROMACS report highlights the increasing use of paediatric VADs. The patient populations with congenital and non-congenital aetiologies exhibit distinct characteristics and clinical outcomes.

Cardiovascular Department Ospedale Papa Giovanni XIII Bergamo Italy

Center for Congenital Heart Disease Department of Cardiac Surgery Inselspital Bern University Hospital University of Bern Bern Switzerland

Centre of Cardiovascular Surgery and Transplantation Brno Czech Republic

Department of Cardiac Surgery and Transplantation Brno Faculty of Medicine Masaryk University Brno Czech Republic

Department of Cardiac Surgery Ghent University Hospital Belgium

Department of Cardiac Surgery Heart Center Leipzig at University of Leipzig Leipzig Germany

Department of Cardiac Surgery Helsinki University Hospital Helsinki Finland

Department of Cardiac Surgery Katholieke Universiteit Leuven Leuven Belgium

Department of Cardiac Surgery Medical University of Innsbruck Innsbruck Austria

Department of Cardiac Surgery National Research Cardiac Surgery Center Astana Kazakhstan

Department of Cardiac Surgery Sant'Orsola University Hospital IRCCS Bologna Bologna Italy

Department of Cardiac Surgery Transplantology and Vascular Surgery Medical University of Silesia Silesian Center for Heart Diseases Zabrze Poland

Department of Cardiac Surgery Vienna Medical University Vienna Austria

Department of Cardio thoracic Surgery Erasmus University Medical Center Rotterdam The Netherlands

Department of Cardiology University of Groningen University Medical Center Groningen Groningen The Netherlands

Department of Cardiovascular and Pneumological Sciences Bambino Gesù Children's Hospital IRCCS Rome Italy

Department of Cardiovascular and Pneumological Sciences Catholic University of Sacred Heart Rome Italy

Department of Cardiovascular Surgery Ege University Hospital Izmir Turkey

Department of Cardiovascular Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Congenital and Pediatric Heart Surgery Children's Heart Clinic University Heart and Vascular Center Hamburg Hamburg Germany

Department of Congenital Cardiac Surgery La Paz University Hospital Madrid Spain

Department of Congenital Heart Defects and Pediatric Cardiology University Heart Center Freiburg Bad Krozingen University of Freiburg Freiburg im Breisgau Germany

Department of Congenital Heart Disease Pediatric Cardiology Deutsches Herzzentrum der Charité Charité Universitaetsmedizin Berlin Berlin Germany

Department of Congenital Pediatric Surgery Children's Hospital Zürich Zürich Switzerland

Department of Surgery for Congenital Heart Defects Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects Heart and Diabetes Centre North Rhine Westphalia Bad Oeynhausen Germany

Department of Surgical Sciences University of Turin Turin Italy

Department of thoracic surgery Utrecht University Medical Center Utrecht The Netherlands

Division of heart failure Cardio Thoracic transplantation and mechanical circulatory support Bambino Gesu children's Hospital Rome

Division of Pediatric Intensive Care Department of Pediatric and Neonatal Intensive Care Erasmus MC Sophia Children's Hospital Rotterdam The Netherlands

EUROMACS EACTS House Windsor UK

Faculty of Medicine of the Comenius University Klinika Kardiochirurgie NUSCH Bratislava Slovakia

Heart and Lung Directorate Great Ormond Street Hospital London UK

Pediatric and Congenital Cardiac Surgery Regina Margherita Children's Hospital Torino Italy

Pediatric Cardiac Surgery Department Royal Children's Hospital Melbourne Australia

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