Impact of center volume on outcomes after ventricular assist device implantation in pediatric patients: An analysis of the STS-Pedimacs database

BACKGROUND:To date, no pediatric studies have highlighted the impact of center's ventricular assist device (VAD) volumes on post-implant outcomes. METHODS:Children (age <19) enrolled in Pedimacs undergoing initial left ventricular assist device implantation from 2012-2020 were included. Center volume was analyzed as a continuous and categorical variable. For categorical analysis, center volumes were divided as: low volume (1-15 implants), medium volume (15-30 implants) and high volume (>30 implants) during our study period. Patient characteristics and outcomes were compared by center's VAD volumes. RESULTS:Of 44 centers, 16 (36.4%) were low, 11 (25%) medium and 17 (38.6%) high volume centers. Children at high volume centers were least likely intubated, sedated, or paralyzed, and most likely ambulating pre-implant (p<0.05 for all). Center's VAD volumes were not a significant risk factor for mortality post-implant when treated as a continuous or a categorical variable (p>0.05). Compared to low volume, children at high volume centers had fewer early neurological events. Compared to medium volume, those at high volume centers had fewer late bleeding events. (p<0.05 for all). There were no significant differences in survival after an adverse event by hospital volumes (p>0.05). CONCLUSION:While hospital volume does not affect post-VAD implant mortality, pediatric centers with higher VAD volumes have fewer patients intubated, sedated, paralyzed pre-implant, and have lower adverse events. Failure to rescue was not significantly different between low, medium, and high-volume VAD centers.