Waitlist mortality in children with EXCOR support: An analysis of the Japan Excor registry.

OBJECTIVES

To reveal the prognostic outcomes of ventricular assist device (VAD) therapy with EXCOR paediatric® in Japan.

METHODS

Patients who underwent EXCOR paediatric implantation as a bridging therapy to transplant between August 2012 and March 2025 were enrolled. The following risk factors were evaluated for their potential to influence waitlist mortality: early surgical era, primary diagnosis, age at implantation, weight at implantation, biventricular VAD support, preoperative extracorporeal membrane oxygenation support, and preoperative mechanical ventilator support.

RESULTS

The total number of 137 patients was identified. The median age and weight at the time of implantation were 15.4 months (interquartile range: 7.3-43.2) and 7.2 kg (5.5-10.9), respectively. The primary diagnosis was dilated cardiomyopathy in 100 patients (72.9%), congenital heart disease in 20 patients (14.6%), and restrictive cardiomyopathy in 8 patients (5.8%). Of those, 70 (51.0%) were supported for a period exceeding one year, and the one-year survival rate was found to be 92.9%. A weight of less than 5 kg at the time of Excor implantation was identified as the sole risk factor for mortality on the waitlist (p = 0.039, Hazard ratio: 2.43, 95% confidence interval: 1.05-5.68). In particular, the mortality rate of patients on the waiting list for congenital heart disease and restrictive cardiomyopathy was comparable to that of patients with dilated cardiomyopathy (p = 0.390, hazard ratio: 1.29, 95% confidence interval: 0.72-2.33).

CONCLUSIONS

An analysis of JEXCOR registry data demonstrated that the prognostic outcome of bridge-to-transplant therapy with Excor paediatric was favorable in Japan.