Understanding Pediatric VAD Center Practices for Establishing and Maintaining Optimal Support

A. Donnellan, C. Villa, D. Peng, S. Auerbach, J. Lantz, J. Murray, L. Smyth, P. Krack, D. L. Sutcliffe

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Ventricular assist device (VAD) interrogations allow clinicians to establish and maintain optimal VAD settings through the support course. There is currently no data regarding standards for establishing and modifying pediatric VAD settings, despite a heterogeneous population with variable diagnoses, anatomy and physiology. METHODS: The Advanced Cardiac Therapies Improving Outcomes Network (ACTION), a 37-center North American learning network, was surveyed in July 2019 regarding current practices for establishing, monitoring and modifying pediatric VAD settings. RESULTS: A total of 25 (68%) centers responded to the survey. Criteria for establishing intraoperative device settings varied between solely surgeon determined (36%) versus global imaging, surgeon, and VAD team driven (60%). Post-operative inpatient and outpatient interrogations were performed predominantly (80%) by a VAD physician or advanced practice provider (APP), but frequency ranged from daily (64%) to weekly (24%) to even monthly (4%). There was consensus (100%) on including device trends and alarm assessment for VAD interrogation, but many centers (88%) include log file interpretation in each interrogation as well. Factors used for optimization of post-operative settings were mixed. Several centers (28%) rely only on device interrogation and clinical course while many (24%) utilize echocardiogram only. The majority (44%) of sites use a combination of echocardiogram and device interrogation to determine optimal support. Outpatient practices were similar amongst sites with the exception of device wean trials which had significant variation with regards to use of echocardiogram (16%), hemodynamic catheterization (8%) or a combination of both studies (76%). Billing practices for VAD interrogation were inconsistent amongst centers, particularly regarding billing frequency. CONCLUSION: VAD interrogation and optimization practices were highly variable amongst ACTION centers, most notably during inpatient hospitalizations. Given the majority of pediatric VAD patients remain hospitalized while on their device, a standardized approach to this process may minimize unnecessary variation. Furthermore, defining "standard" management approaches and device settings in varied pediatric populations may help define the optimal clinical approach to support.

Original languageEnglish (US)
Pages (from-to)S495
JournalThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2020
Externally publishedYes

ASJC Scopus subject areas

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

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