Steroid Utilization for Pediatric Ventricular Assist Device-Associated Inflammation and Association With Outcomes
Retrospective cohort published in ASAIO Journal (2025)
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
In 68 pediatric VAD patients, methylprednisolone use in 49% reduced CRP and fibrinogen but was associated with higher rates of stroke, infection, and pump thrombosis, along with elevated bivalirudin dose requirements.
Why This Matters for Hirudotherapy
This single-center retrospective study of 68 pediatric ventricular assist device (VAD) patients examined methylprednisolone (MP) utilization for device-associated inflammation, finding that MP (used in 49% of patients) significantly reduced CRP and fibrinogen but was associated with higher proportions of stroke, infection, and pump thrombosis. Patients receiving MP also had higher bivalirudin doses in the second week post-implant. The study centers on corticosteroid use for inflammation, not on anticoagulation. Bivalirudin (formerly Hirulog) is a synthetic peptide anticoagulant designed partly on the C-terminal sequence of hirudin, the anticoagulant of the medicinal leech (Maraganore et al., 1990); this paper studies the drug, not leech therapy.
Citation
Reference (Vancouver style)
Ankola AA, Tunuguntla HP, Hope KD, Spinner JA, Choudhry S, Adachi I, et al. Steroid Utilization for Pediatric Ventricular Assist Device-Associated Inflammation and Association With Outcomes. ASAIO J. 2025;71(9):752-759. doi:10.1097/MAT.0000000000002416. PMID: 40105063
Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.
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