The Ninth Annual STS-Pedimacs Report: Pediatric VAD Outcomes and the Expanding Role of Biventricular Support

BACKGROUND This Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) report provides the most comprehensive update on pediatric ventricular assist device (VAD) outcomes, including for those requiring biventricular support. METHODS From September 19, 2012, to December 31, 2024, 1465 patients have undergone VAD implantation. RESULTS Children with congenital heart disease (CHD) undergoing VAD implant continue to increase (28%). For patients with cardiomyopathy, 93% had dilated cardiomyopathy. For those with CHD, 61% had single ventricle CHD. Implantable continuous (IC) VADs were the most commonly implanted devices (508, 35%). For the overall Pedimacs cohort, survival at 6-months on device was 77%, and at 1-year was 73%. Survival on the device was greatest among patient ages 11-19, cardiomyopathy and those implanted with IC VADs. Transplant rates and survival were significantly lower for children with single ventricle CHD compared to cardiomyopathy patients. There has been a successive improvement in survival among pediatric patients supported on a VAD over time (2012-2015 vs. 2016-2020 vs. 2021-2024). BiVAD supported patients had a higher pre-implant acuity and significantly lower survival than those undergoing only LVAD implantation. CONCLUSIONS This annual Pedimacs report highlights the continued rise in VAD support for children with end-stage heart failure and with improving outcomes. There are significant differences in clinical characteristics and patient outcomes among patients supported with different device types. This report provides a comprehensive analysis of pediatric patients supported with biventricular support.