Steroid Utilization for Pediatric Ventricular Assist Device-Associated Inflammation and Association With Outcomes.

Abstract

The impact of methylprednisolone (MP) on ventricular assist device (VAD)-associated inflammation in children and its association with outcomes remains unclear. We report this single-center retrospective study of children less than 21 years old supported with a VAD from February 2018 to December 2022. Methylprednisolone utilization, serial laboratory markers of hemolysis, inflammation, anticoagulation, and VAD adverse outcomes were analyzed. Sixty-eight patients (47% male, median age 3.2 years, 54% pulsatile flow) were included. Thirty-three patients (49%) received MP during VAD support, starting at a median 9 days post-implant (interquartile range [IQR]: 7-14), and for a median of 4 days (IQR: 3-5). Post-MP, there was a significant reduction in c-reactive protein (CRP) (12.4-3.2 mg/dl, p < 0.001) and fibrinogen (592-325 mg/dl, p < 0.001). Patients receiving MP had a higher daily rate of decline of fibrinogen (p = 0.024) and higher bivalirudin dose (p = 0.013) in the 2nd week post-implant. Methylprednisolone utilization was associated with higher proportion of stroke (p = 0.023), infection (p = 0.010), and pump thrombosis (p = 0.023). Methylprednisolone is used frequently during pediatric VAD support and reduces inflammatory markers. Infectious and thrombotic complications were more common in the cohort receiving MP, and larger studies are needed to investigate this further.