Ventricular Assist Devices in Pediatric Patients

Jul 20, 2018
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Authors:
Dipchand AI, Kirk R, Naftel DC, et al.
Citation:
Ventricular Assist Device Support as a Bridge to Transplantation in Pediatric Patients. J Am Coll Cardiol 2018;72:402-415.
Summary By:
Timothy B. Cotts, MD, FACC

Study Questions:

What are the outcomes of ventricular assist device (VAD) support as a bridge to heart transplantation (HTx) in children in a large international multicenter cohort?

Methods:

Data from the Pediatric Heart Transplant Study were used to make comparisons between children supported to HTx between January 1993 and December 2015 with VAD or extracorporeal membrane oxygenation (ECMO) to VAD support.

Results:

Of 7,135 patients listed for HTx during the study period, 5,145 were transplanted. Of the total cohort, 995 (19.3%) were supported by a VAD, of which 113 had congenital heart disease (CHD). In the VAD-only cohort (n = 821), 79% underwent HTx and 14% died, as compared with the ECMO-to-VAD cohort, in which 69% underwent transplant and 24% died. Patients with cardiomyopathy achieved HTx 84% of the time, with a 9% waitlist mortality as compared with the CHD group, in which 55% were transplanted with a 36% mortality. 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.

Conclusions:

The authors concluded that major advances have occurred in mechanical support technology for children. Significant challenges remain for neonates and patients with CHD.

Perspective:

This study is the largest international multicenter report of pediatric patients with VAD support as a bridge to cardiac transplantation. The study confirms previous research showing superior outcomes for patients with cardiomyopathy as compared with those with CHD. Patients with cardiomyopathy had both a greater chance of being transplanted as well as a lower waitlist mortality rate. The results were also consistent with other recent reports suggesting better outcomes for patients supported with continuous-flow VADs as compared with pulsatile VADs. Further study of the impact of VAD type on longer-term outcomes and in the heterogeneous pediatric VAD population in a contemporary cohort is necessary.

Keywords: Cardiomyopathies, Extracorporeal Membrane Oxygenation, Heart Defects, Congenital, Heart Failure, Heart Transplantation, Heart-Assist Devices, Infant, Newborn, Outcome Assessment, Health Care, Pediatrics


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