Infectious Adverse Events in Pediatric Paracorporeal Ventricular Assist Devices: An Analysis of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Registry

Infectious adverse events (IAEs) are common in children supported with paracorporeal ventricular assist devices (VADs). This study aimed to identify risk factors for IAEs from the Advanced Cardiac Therapy Improving Outcomes Network (ACTION) registry. We conducted a retrospective study including pediatric patients supported with paracorporeal VADs. Patients were stratified by device type (paracorporeal pulsatile [PP], paracorporeal continuous [PC], or overlapping). Kaplan-Meier analysis, the log-rank test, and Cox proportional hazards models evaluated factors associated with survival and time to first IAE. Among 812 patients on paracorporeal VADs, 270 (33.2%) experienced IAEs (479 events). Localized non-device IAEs were most common (40.9%). Patients with IAEs were younger, had lower body surface area (BSA), were more likely to require mechanical ventilation pre-implant, and had longer VAD support duration. Freedom from IAEs was lower in patients with PC devices or overlapping support (p = 0.0081). Survival was worse after IAEs (p = 0.0096). Overlapping device support was independently associated with an increased risk of IAE (hazard ratio [HR]: 1.387; p = 0.0354), while larger BSA was protective (HR: 0.542; p = 0.0264). IAEs remain common in children on VAD support and are associated with mortality, with device overlaps and smaller patient size as independent risk factors.