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

Pediatric Heart Transplant Study Investigators

Research output: Contribution to journalArticle

13 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)402-415
Number of pages14
JournalJournal of the American College of Cardiology
Volume72
Issue number4
DOIs
StatePublished - Jul 24 2018

Fingerprint

Heart-Assist Devices
Transplantation
Pediatrics
Newborn Infant
Survival
Heart Transplantation
Technology
Transplants

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ventricular Assist Device Support as a Bridge to Transplantation in Pediatric Patients. / Pediatric Heart Transplant Study Investigators.

In: Journal of the American College of Cardiology, Vol. 72, No. 4, 24.07.2018, p. 402-415.

Research output: Contribution to journalArticle

Pediatric Heart Transplant Study Investigators. / Ventricular Assist Device Support as a Bridge to Transplantation in Pediatric Patients. In: Journal of the American College of Cardiology. 2018 ; Vol. 72, No. 4. pp. 402-415.
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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.",
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author = "{Pediatric Heart Transplant Study Investigators} and Dipchand, {Anne I.} and Richard Kirk and Naftel, {David C.} and Elizabeth Pruitt and Blume, {Elizabeth D.} and Robert Morrow and David Rosenthal and Scott Auerbach and Richmond, {Marc E.} and Kirklin, {James K.}",
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AU - Pediatric Heart Transplant Study Investigators

AU - Dipchand, Anne I.

AU - Kirk, Richard

AU - Naftel, David C.

AU - Pruitt, Elizabeth

AU - Blume, Elizabeth D.

AU - Morrow, Robert

AU - Rosenthal, David

AU - Auerbach, Scott

AU - Richmond, Marc E.

AU - Kirklin, James K.

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N2 - 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.

AB - 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.

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