Risk factors for prolonged mechanical ventilation for children on ventricular assist device support

Parthak Prodhan, Giridhar Kalikivenkata, Xinyu Tang, Kassandra Thomas, Jonathan Byrnes, Michiaki Imamura, Robert D B Jaquiss, Xiomara Garcia, Elizabeth A. Frazier, Adnan T. Bhutta, Umesh Dyamenahalli

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Background Patients with end-stage heart failure possess many attributes that place them at risk for prolonged mechanical ventilation (MV). However, there are only limited data on MV support among children after ventricular assist device (VAD) implantation. We report the duration of MV after VAD placement, indications for respiratory support in the postimplantation period, and associated patient factors. Methods This single-center retrospective study included 43 consecutive children (aged <18 years) with end-stage heart failure who were supported with a VAD as a bridge to transplantation from January 2005 to December 2011. Multivariable analysis was performed using the multiple Poisson regression model for the duration of MV. Results Overall, 33% (n = 14) remained on MV until heart transplant or death. Of those requiring pre-VAD extracorporeal membrane oxygenation (ECMO) support, 63% (n = 12 of 19) remained on MV until heart transplant or death compared with 8% (n = 2 of 24) among those not on ECMO before VAD (p < 0.001). Patients with moderate or severe mitral regurgitation while on VAD support had 1.7-times more MV days compared with those with none or trivial on-VAD mitral regurgitation. In addition, previous support on ECMO, those with moderate or severe tricuspid regurgitation, and those with only left VAD implants had an increased risk of prolonged MV. Conclusions Our results suggest that VAD recipients previously supported on ECMO, those with moderate or severe mitral regurgitation, moderate or severe tricuspid regurgitation, and those with only left VAD implants had an increased risk of prolonged MV. Future studies in larger cohorts are necessary to confirm the findings from this single-institutional experience.

Original languageEnglish (US)
Pages (from-to)1713-1718
Number of pages6
JournalAnnals of Thoracic Surgery
Volume99
Issue number5
DOIs
StatePublished - Jan 1 2015

ASJC Scopus subject areas

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

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    Prodhan, P., Kalikivenkata, G., Tang, X., Thomas, K., Byrnes, J., Imamura, M., Jaquiss, R. D. B., Garcia, X., Frazier, E. A., Bhutta, A. T., & Dyamenahalli, U. (2015). Risk factors for prolonged mechanical ventilation for children on ventricular assist device support. Annals of Thoracic Surgery, 99(5), 1713-1718. https://doi.org/10.1016/j.athoracsur.2014.12.068