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J Am Coll Cardiol. 2018 Jul 24;72(4):402-415. doi: 10.1016/j.jacc.2018.04.072.

Ventricular Assist Device Support as a Bridge to Transplantation in Pediatric Patients.

Author information

1
Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: anne.dipchand@sickkids.ca.
2
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
3
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
4
Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
5
Department of Pediatrics, Children's Health System of Texas, Dallas, Texas.
6
Department of Pediatrics, Stanford University, Palo Alto, California.
7
Division of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado.
8
Department of Pediatrics, Morgan Stanley Children's Hospital-Columbia University Medical Center, New York, New York.
9
Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.

Abstract

BACKGROUND:

Pediatric ventricular assist device (VAD) use has evolved dramatically over the last 2 decades.

OBJECTIVES:

This study sought to describe the evolution of VAD support to heart transplantation (HTx) in children in a large international multicenter cohort.

METHODS:

Using data from the Pediatric Heart Transplant Study, comparisons were made between children (<18 years) supported to HTx (January 1, 1993 to December 31, 2015) with VAD or extracorporeal membrane oxygenation (ECMO) to VAD support.

RESULTS:

Of 7,135 listed patients, 5,145 underwent HTx; 995 (19.3%) were supported by a VAD (113 with congenital heart disease [CHD]). Patients with a VAD as their first device (n = 821) were older, larger, and more likely to have cardiomyopathy (80%) than patients transitioned from ECMO to VAD (n = 164). In the VAD-only cohort, 79% underwent HTx and 14% died, compared with 69% and 24% in the ECMO-to-VAD cohort, respectively. Patients with cardiomyopathy achieved HTx 84% of the time, with a 9% waitlist mortality rate compared with 55% and 36%, respectively, for CHD. Among VAD-treated patients, 79% were age >10 years in the earliest era, a percentage decreasing to 34% more recently, though neonates still represent <1%. Overall, survival at 2 and 20 years showed no difference between VAD and no support (2 years: 75% vs. 80%; 20 years: 55% vs. 54%). Post-HTx outcomes were better for durable versus temporary VADs (p < 0.01) and for continuous versus pulsatile VADs (p < 0.01) from 2005 onward; timing of VAD had no impact on post-HTx survival (p = 0.65).

CONCLUSIONS:

For one-quarter of a century, major advances have occurred in mechanical support technology for children, thereby expanding the capability to bridge to HTx without compromising post-HTx outcomes. Significant challenges remain, especially for neonates and patients with CHD, but ongoing innovation portends improved methods of support during the next decade.

KEYWORDS:

durable; extracorporeal membrane oxygenation; heart failure; outcomes; survival

PMID:
30025576
DOI:
10.1016/j.jacc.2018.04.072
[Indexed for MEDLINE]
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