Outcomes of children with congenital heart disease implanted with ventricular assist devices: An analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs)

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:38

Article

Peng, David M.¹  Koehl, Devin A.²  Cantor, Ryan S.²  McMillan, Kristen N.³  Barnes, Aliessa P.⁴  McConnell, Patrick, I⁵  Jordan, Jessica¹  Andersen, Nicholas D.⁶  St Louis, James D.⁴  Maeda, Katsuhide⁷  Kirklin, James K.²  Kindel, Steven J.⁸ 

[1] Univ Michigan, Dept Pediat, Div Pediat Cardiol, Ann Arbor, MI 48109 USA

[2] Univ Alabama Birmingham, Kirklin Inst Res Surg Outcomes, Birmingham, AL USA

[3] Johns Hopkins Univ, Dept Anesthesiol & Crit Care Med, Baltimore, MD USA

[4] Univ Missouri, Dept Pediat, Div Pediat Cardiol, Kansas City, MO 64110 USA

[5] Ohio State Univ, Dept Cardiothorac Surg, Columbus, OH 43210 USA

[6] Harvard Univ, Dept Cardiac Surg, Boston, MA 02115 USA

[7] Stanford Univ, Dept Cardiothorac Surg, Palo Alto, CA 94304 USA

[8] Med Coll Wisconsin, Div Pediat Cardiol, Dept Pediat, Milwaukee, WI 53226 USA

关键词: congenital heart disease;    heart failure;    heart transplantation;    outcomes;    pediatrics;    pediatric heart failure;    pediatric heart transplantation;    ventricular assist device;   

DOI  :  10.1016/j.healun.2018.10.008

来源: Elsevier

【 摘 要 】

BACKGROUND: The reported ventricular assist device (VAD) experience in the pediatric congenital heart disease (CHD) population is limited. We sought to describe contemporary use and outcomes of VADs in children with CHD and compare these outcomes to those of non-CHD children. METHODS: Patients enrolled in the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) between September 19, 2012 through June 30, 2017 were included. CHD was classified as biventricular vs single ventricle (Stages 1, 2, or 3). Outcomes were compared between groups and multivariable analysis was used to identify factors associated with mortality on the device. RESULTS: Among the 471 patients enrolled, 108 (24%) had CHD (45 biventricular and 63 single ventricle). CHD patients were younger (5.7 +/- 5.7 years vs 9.8 6.5 years; p < 0.0001) and smaller (0.8 +/- 0.5 m(2) vs 1.2 +/- 0.7 m2; p < 0.0001) compared with non-CHD patients. CHD patients were more likely to receive a paracorporeal continuous-flow VAD (36.1% vs 12.9%; p < 0.0001) and less likely to receive an implantable continuous-flow VAD (27.8% vs 55.0%; p < 0.0001) compared with non-CHD patients. After 6 months on a VAD, CHD patients had higher mortality (36.4% vs 12.1%) and a lower transplantation rate (29.1% vs 59.9%) than non-CHD patients (p < 0.0001). In the multivariable analysis, CHD was the factor most strongly associated with mortality on VAD (hazard ratio [HR] = 2.9; p < 0.0001), whereas the factors implantable continuous-flow device and high-volume center were protective (HR = 0.3, p < 0.0001, and HR = 0.6, respectively; p = 0.02). CONCLUSIONS: VAD use in children with CHD is associated with increased mortality and decreased transplant rates compared to children without CHD. For the subgroup of children with CHD who received implantable continuous-flow VADs, survival rates were higher and comparable to those of children without CHD. Increased experience correlated with better survival in pediatric VADs. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.

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