David L Sutcliffe1, Elizabeth Pruitt2, Ryan S Cantor2, Justin Godown3, John Lane4, Mark W Turrentine5, Sabrina P Law6, Jodie L Lantz7, James K Kirklin2, Daniel Bernstein8, Elizabeth D Blume9. 1. Department of Pediatric Cardiology, Children's Health Dallas, UT Southwestern, Dallas, Texas, USA. Electronic address: davidsutcliffemd@gmail.com. 2. Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama, USA. 3. Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital of the Vanderbilt University Medical Center, Nashville, Tennessee, USA. 4. Department of Pediatric Critical Care, Phoenix Children's Hospital, Phoenix, Arizona, USA. 5. Department of Cardiac Surgery, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana, USA. 6. Department of Pediatric Cardiology, Columbia University-Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York, USA. 7. Department of Pediatric Cardiology, Children's Health Dallas, Dallas, Texas, USA. 8. Department of Pediatric Cardiology, Lucile Packard Children's Hospital of Stanford University, Palo Alto, California, USA. 9. Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Pediatric ventricular assist device (VAD) support as bridge to transplant has improved waitlist survival, but the effects of pre-implant status and VAD-related events on post-transplant outcomes have not been assessed. This study is a linkage analysis between the PediMACS and Pediatric Heart Transplant Study databases to determine the effects of VAD course on post-transplant outcomes. METHODS: Database linkage between October 1, 2012 and December 31, 2015 identified 147 transplanted VAD patients, the primary study group. The comparison cohort was composed of 630 PHTS patients without pre-transplant VAD support. The primary outcome was post-transplant survival, with secondary outcomes of post-transplant length of stay, freedom from infection and freedom from rejection. RESULTS: At implant, the VAD cohort was INTERMACS Profile 1 in 33 (23%), Profile 2 in 89 (63%) and Profile 3 in 14 (10%) patients. The VAD cohort was older, larger, and less likely to have congenital heart disease (p < 0.0001). However, they had greater requirements for inotrope and ventilator support and increased liver and renal dysfunction (p < 0.0001), both of which normalized at transplant after device support. Importantly, there were no differences in 1-year post-transplant survival (96% vs 93%, p = 0.3), freedom from infection (81% vs 79%, p = 0.9) or freedom from rejection (71% vs 74%, p = 0.87) between cohorts. CONCLUSIONS: Pediatric VAD patients have post-transplant outcomes equal to that of medically supported patients, despite greater pre-implant illness severity. Post-transplant survival, hospital length of stay, infection and rejection were not affected by patient acuity at VAD implantation or VAD-related complications. Therefore, VAD as bridge to transplant mitigates severity of illness in children.
BACKGROUND: Pediatric ventricular assist device (VAD) support as bridge to transplant has improved waitlist survival, but the effects of pre-implant status and VAD-related events on post-transplant outcomes have not been assessed. This study is a linkage analysis between the PediMACS and Pediatric Heart Transplant Study databases to determine the effects of VAD course on post-transplant outcomes. METHODS: Database linkage between October 1, 2012 and December 31, 2015 identified 147 transplanted VAD patients, the primary study group. The comparison cohort was composed of 630 PHTSpatients without pre-transplant VAD support. The primary outcome was post-transplant survival, with secondary outcomes of post-transplant length of stay, freedom from infection and freedom from rejection. RESULTS: At implant, the VAD cohort was INTERMACS Profile 1 in 33 (23%), Profile 2 in 89 (63%) and Profile 3 in 14 (10%) patients. The VAD cohort was older, larger, and less likely to have congenital heart disease (p < 0.0001). However, they had greater requirements for inotrope and ventilator support and increased liver and renal dysfunction (p < 0.0001), both of which normalized at transplant after device support. Importantly, there were no differences in 1-year post-transplant survival (96% vs 93%, p = 0.3), freedom from infection (81% vs 79%, p = 0.9) or freedom from rejection (71% vs 74%, p = 0.87) between cohorts. CONCLUSIONS: Pediatric VAD patients have post-transplant outcomes equal to that of medically supported patients, despite greater pre-implant illness severity. Post-transplant survival, hospital length of stay, infection and rejection were not affected by patient acuity at VAD implantation or VAD-related complications. Therefore, VAD as bridge to transplant mitigates severity of illness in children.
Authors: Justin Godown; Andrew H Smith; Cary Thurm; Matt Hall; Debra A Dodd; Jonathan H Soslow; Bret A Mettler; David W Bearl; Brian Feingold Journal: Am Heart J Date: 2018-04-06 Impact factor: 4.749
Authors: Melissa K Cousino; Heang M Lim; Cynthia Smith; Sunkyung Yu; Ray Lowery; Suzanne Viers; Amanda D McCormick; David M Peng; Karen Uzark; Kurt R Schumacher Journal: Pediatr Cardiol Date: 2022-04-04 Impact factor: 1.838