Right heart failure with left ventricular assist device implantation in children: An analysis of the Pedimacs registry database

Kathleen E. Simpson, James K. Kirklin, Ryan S. Cantor, Mary Mehegan, Jacqueline M. Lamour, Kristine J. Guleserian, David M. Peng, Elfriede Pahl

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The use of ventricular assist device (VAD) in children has increased, but the decision of left VAD (LVAD) vs biventricular support remains a challenge. Children who undergo LVAD placement are at risk for right ventricular failure (RHF), but the incidence has not been described. METHODS: Analysis was performed for patients <18 years old who underwent durable LVAD placement within the Pedimacs registry (September 19, 2012–February 28, 2017), excluding single ventricle morphology and temporary devices. RHF was defined as the need for right ventriculalr assist device (RVAD) or prolonged inotrope use between 1 week to 1 month and 1 to 3 months. End-points included death, heart transplant (HT), and recovery. RESULTS: A total of 272 durable LVAD were placed of which 37 died on device over 24 month follow-up, primarily from multiorgan failure and neurologic dysfunction. RVAD occurred in 12 children at median 8.5 days, with 9 undergoing HT and 3 dying on device. In patients with only LVAD, RHF was present in 111/207 (55%) between 1 week to 1 month and 28/116 (25%) between 1 and 3 months. Younger age, smaller weight, Intermacs profile 1, chemical paralysis, and pulsatile flow VAD were associated with RHF. RHF was associated with increased risk of death on device at both >1 month (hazard ratio 3.2, 95% CI 1.4–7.7, p = 0.007) and >3 month (hazard ratio 6.9, 95% CI 2–23.1, p = 0.002). CONCLUSIONS: In children, RHF is common after durable LVAD implantation, but subsequent RVAD is relatively rare. RHF in children, as indicated by prolonged inotrope support, was associated with an increased risk of death on the device. Whether early RVAD support and higher waitlist status may improve the outcome remains unknown.

Original languageEnglish (US)
Pages (from-to)231-240
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number3
DOIs
StatePublished - Mar 2020
Externally publishedYes

Keywords

  • heart transplant
  • pediatric
  • pedimacs
  • right heart failure
  • ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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