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Outcomes of Ventricular Assist Device Placement in Pediatric Patients With Renal Dysfunction Requiring Dialysis: An ACTION Registry Analysis

Year: 2026

Type: article

Abstract: BACKGROUND: Renal dysfunction requiring renal replacement therapy (RRT) is associated with poor outcomes after ventricular assist device (VAD) implantation in adults. However, outcomes in pediatric patients are not well described. We aim to characterize pediatric patients supported by RRT who undergo VAD implantation and to assess the short- and long-term outcomes. METHODS: The Advanced Cardiac Therapies Improving Outcomes Network Registry contains preoperative and postoperative data on pediatric patients with VAD across 57 North American sites (April 2018-June 2025). Patients were stratified by RRT use at surgery, including chronic dialysis and newly initiated RRT. Patient characteristics, preoperative data, and clinical outcomes including 1-year post-VAD survival, likelihood of transplantation, and post-transplantation survival were assessed using Kaplan-Meier survival, multivariable Cox proportional hazards models, and competing risk analysis. RESULTS: Of 1607 patients undergoing VAD implantation, 75 (4.7%) were supported by RRT at surgery. These patients had worse clinical status, including a higher incidence of extracorporeal membrane oxygenation support, higher Interagency Registry for Mechanically Assisted Circulatory Support classification, and higher total bilirubin. Patients who underwent RRT were less likely to undergo heart transplantation (33/75 [44.0%] vs 941/1532 [61.4%], P < .001) and had higher mortality rates postimplantation. Kaplan-Meier survival analysis revealed lower 1-year survival in patients who underwent RRT (58.4% vs 78.3%, P < .001). However, in multivariable Cox analysis, RRT was not independently associated with 1-year mortality risk (hazard ratio, 1.31; 95% CI, 0.81-2.10; P = .273). CONCLUSIONS: Renal dysfunction requiring RRT is rare in children undergoing VAD placement. Although these patients demonstrate worse clinical status and higher mortality, RRT is not independently associated with mortality risk, suggesting that the underlying illness severity drives outcomes.

Source: The Annals of Thoracic Surgery

DOI: 10.1016/j.athoracsur.2026.09.014