The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: An analysis of the United Network for Organ Sharing database

Ryan R Davies, Mark J. Russo, Kimberly N. Hong, Michael L. O'Byrne, David P. Cork, Alan J. Moskowitz, Annetine C. Gelijns, Seema Mital, Ralph S. Mosca, Jonathan M. Chen

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Objectives: The use of mechanical circulatory support to bridge pediatric patients to cardiac transplantation presents unique challenges because of the difficult anatomy and physiology in these patients. Methods: The United Network for Organ Sharing provided deidentifed patient-level data. The study population included 2532 transplantations performed on patients less than 19 years old in status 1/1A/1B between 1995 and 2005. Mechanical circulatory support was used in 431 patients: 241 (9.5%) received ventricular assist devices, 171 (6.8%) underwent extracorporeal membrane oxygenation, and 19 (0.8%) received intra-aortic balloon pumps. Results: Patients supported on ventricular assist devices had similar levels of hospitalization and intensive care use and less need for inotropic support (P < .0002) than had those not needing support. Five- and 10-year posttransplantation survival was better in patients receiving ventricular assist devices and patients not receiving mechanical circulatory support than in patients receiving extracorporeal membrane oxygenation or intra-aortic balloon pumping (P < .0001). Among mechanically supported patients, patients with a body surface area of less than 0.30 (odds ratio, 1.70; 95% confidence interval, 1.18-2.43) and those requiring extracorporeal membrane oxygenation (odds ratio, 1.65; 95% confidence interval, 1.15-2.35) or intra-aortic balloon pumping (odds ratio, 1.91; 95% confidence interval, 1.02-3.56) had higher long-term mortality. The use of a ventricular assist device at transplantation did not predict higher long-term, posttransplantation mortality. Conclusions: Pediatric patients requiring a pretransplantation ventricular assist device have long-term survival similar to that of patients not receiving mechanical circulatory support. Early survival among patients undergoing extracorporeal membrane oxygenation and infants is poor, reinforcing the need for improvements in device design and physiologic management of infants and neonates.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume135
Issue number2
DOIs
StatePublished - Feb 1 2008

Fingerprint

Transplantation
Databases
Pediatrics
Heart-Assist Devices
Extracorporeal Membrane Oxygenation
Intra-Aortic Balloon Pumping
Odds Ratio
Confidence Intervals
Survival
Equipment Design
Mortality
Body Surface Area
Heart Transplantation
Critical Care
Anatomy
Hospitalization
Newborn Infant

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

The use of mechanical circulatory support as a bridge to transplantation in pediatric patients : An analysis of the United Network for Organ Sharing database. / Davies, Ryan R; Russo, Mark J.; Hong, Kimberly N.; O'Byrne, Michael L.; Cork, David P.; Moskowitz, Alan J.; Gelijns, Annetine C.; Mital, Seema; Mosca, Ralph S.; Chen, Jonathan M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 135, No. 2, 01.02.2008.

Research output: Contribution to journalArticle

Davies, Ryan R ; Russo, Mark J. ; Hong, Kimberly N. ; O'Byrne, Michael L. ; Cork, David P. ; Moskowitz, Alan J. ; Gelijns, Annetine C. ; Mital, Seema ; Mosca, Ralph S. ; Chen, Jonathan M. / The use of mechanical circulatory support as a bridge to transplantation in pediatric patients : An analysis of the United Network for Organ Sharing database. In: Journal of Thoracic and Cardiovascular Surgery. 2008 ; Vol. 135, No. 2.
@article{17495ebff0944d07962e2bdd3291e014,
title = "The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: An analysis of the United Network for Organ Sharing database",
abstract = "Objectives: The use of mechanical circulatory support to bridge pediatric patients to cardiac transplantation presents unique challenges because of the difficult anatomy and physiology in these patients. Methods: The United Network for Organ Sharing provided deidentifed patient-level data. The study population included 2532 transplantations performed on patients less than 19 years old in status 1/1A/1B between 1995 and 2005. Mechanical circulatory support was used in 431 patients: 241 (9.5{\%}) received ventricular assist devices, 171 (6.8{\%}) underwent extracorporeal membrane oxygenation, and 19 (0.8{\%}) received intra-aortic balloon pumps. Results: Patients supported on ventricular assist devices had similar levels of hospitalization and intensive care use and less need for inotropic support (P < .0002) than had those not needing support. Five- and 10-year posttransplantation survival was better in patients receiving ventricular assist devices and patients not receiving mechanical circulatory support than in patients receiving extracorporeal membrane oxygenation or intra-aortic balloon pumping (P < .0001). Among mechanically supported patients, patients with a body surface area of less than 0.30 (odds ratio, 1.70; 95{\%} confidence interval, 1.18-2.43) and those requiring extracorporeal membrane oxygenation (odds ratio, 1.65; 95{\%} confidence interval, 1.15-2.35) or intra-aortic balloon pumping (odds ratio, 1.91; 95{\%} confidence interval, 1.02-3.56) had higher long-term mortality. The use of a ventricular assist device at transplantation did not predict higher long-term, posttransplantation mortality. Conclusions: Pediatric patients requiring a pretransplantation ventricular assist device have long-term survival similar to that of patients not receiving mechanical circulatory support. Early survival among patients undergoing extracorporeal membrane oxygenation and infants is poor, reinforcing the need for improvements in device design and physiologic management of infants and neonates.",
author = "Davies, {Ryan R} and Russo, {Mark J.} and Hong, {Kimberly N.} and O'Byrne, {Michael L.} and Cork, {David P.} and Moskowitz, {Alan J.} and Gelijns, {Annetine C.} and Seema Mital and Mosca, {Ralph S.} and Chen, {Jonathan M.}",
year = "2008",
month = "2",
day = "1",
doi = "10.1016/j.jtcvs.2007.09.048",
language = "English (US)",
volume = "135",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - The use of mechanical circulatory support as a bridge to transplantation in pediatric patients

T2 - An analysis of the United Network for Organ Sharing database

AU - Davies, Ryan R

AU - Russo, Mark J.

AU - Hong, Kimberly N.

AU - O'Byrne, Michael L.

AU - Cork, David P.

AU - Moskowitz, Alan J.

AU - Gelijns, Annetine C.

AU - Mital, Seema

AU - Mosca, Ralph S.

AU - Chen, Jonathan M.

PY - 2008/2/1

Y1 - 2008/2/1

N2 - Objectives: The use of mechanical circulatory support to bridge pediatric patients to cardiac transplantation presents unique challenges because of the difficult anatomy and physiology in these patients. Methods: The United Network for Organ Sharing provided deidentifed patient-level data. The study population included 2532 transplantations performed on patients less than 19 years old in status 1/1A/1B between 1995 and 2005. Mechanical circulatory support was used in 431 patients: 241 (9.5%) received ventricular assist devices, 171 (6.8%) underwent extracorporeal membrane oxygenation, and 19 (0.8%) received intra-aortic balloon pumps. Results: Patients supported on ventricular assist devices had similar levels of hospitalization and intensive care use and less need for inotropic support (P < .0002) than had those not needing support. Five- and 10-year posttransplantation survival was better in patients receiving ventricular assist devices and patients not receiving mechanical circulatory support than in patients receiving extracorporeal membrane oxygenation or intra-aortic balloon pumping (P < .0001). Among mechanically supported patients, patients with a body surface area of less than 0.30 (odds ratio, 1.70; 95% confidence interval, 1.18-2.43) and those requiring extracorporeal membrane oxygenation (odds ratio, 1.65; 95% confidence interval, 1.15-2.35) or intra-aortic balloon pumping (odds ratio, 1.91; 95% confidence interval, 1.02-3.56) had higher long-term mortality. The use of a ventricular assist device at transplantation did not predict higher long-term, posttransplantation mortality. Conclusions: Pediatric patients requiring a pretransplantation ventricular assist device have long-term survival similar to that of patients not receiving mechanical circulatory support. Early survival among patients undergoing extracorporeal membrane oxygenation and infants is poor, reinforcing the need for improvements in device design and physiologic management of infants and neonates.

AB - Objectives: The use of mechanical circulatory support to bridge pediatric patients to cardiac transplantation presents unique challenges because of the difficult anatomy and physiology in these patients. Methods: The United Network for Organ Sharing provided deidentifed patient-level data. The study population included 2532 transplantations performed on patients less than 19 years old in status 1/1A/1B between 1995 and 2005. Mechanical circulatory support was used in 431 patients: 241 (9.5%) received ventricular assist devices, 171 (6.8%) underwent extracorporeal membrane oxygenation, and 19 (0.8%) received intra-aortic balloon pumps. Results: Patients supported on ventricular assist devices had similar levels of hospitalization and intensive care use and less need for inotropic support (P < .0002) than had those not needing support. Five- and 10-year posttransplantation survival was better in patients receiving ventricular assist devices and patients not receiving mechanical circulatory support than in patients receiving extracorporeal membrane oxygenation or intra-aortic balloon pumping (P < .0001). Among mechanically supported patients, patients with a body surface area of less than 0.30 (odds ratio, 1.70; 95% confidence interval, 1.18-2.43) and those requiring extracorporeal membrane oxygenation (odds ratio, 1.65; 95% confidence interval, 1.15-2.35) or intra-aortic balloon pumping (odds ratio, 1.91; 95% confidence interval, 1.02-3.56) had higher long-term mortality. The use of a ventricular assist device at transplantation did not predict higher long-term, posttransplantation mortality. Conclusions: Pediatric patients requiring a pretransplantation ventricular assist device have long-term survival similar to that of patients not receiving mechanical circulatory support. Early survival among patients undergoing extracorporeal membrane oxygenation and infants is poor, reinforcing the need for improvements in device design and physiologic management of infants and neonates.

UR - http://www.scopus.com/inward/record.url?scp=37549068784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=37549068784&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2007.09.048

DO - 10.1016/j.jtcvs.2007.09.048

M3 - Article

C2 - 18242279

AN - SCOPUS:37549068784

VL - 135

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 2

ER -