Madeleine Townsend1, Tara Karamlou2, Gerard Boyle3, Kevin Daly4, Shriprasad Deshpande5, Scott R Auerbach6, Sarah Worley7, Wei Liu7, Elizabeth Saarel8, Shahnawaz Amdani9. 1. Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada. 2. Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. 3. Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA. 4. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA. 5. Pediatric Cardiology, Children's National Hospital, George Washington University, Washington, District of Columbia, USA. 6. Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. 7. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA. 8. Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA; and St. Luke's Health System, Boise, Idaho, USA. 9. Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA. Electronic address: amdanis@ccf.org.
Abstract
BACKGROUND: We evaluated the impact of pediatric heart-allocation policy changes over time and the approval of the Berlin ventricular assist device (VAD) on waitlist (WL) outcomes for children with congenital heart disease (CHD). METHODS: The Scientific Registry of Transplant Recipients database was evaluated to include all children (age < 18) with CHD and cardiomyopathy (CMP) on the WL between 1999 and 2019, divided into 4 eras: Era 1 (1999-2008); Era 2 (2009-2011); Era 3 (2012-2016); and Era 4 (2016-2019). WL characteristics and survival outcomes were evaluated for patients with CHD over time and were compared to those with CMP listed currently (Era 4). RESULTS: We included 5185 children with CHD on the WL during the study period; 1999 (39%) were listed in Era 1; 693 (13%) in Era 2; 1196 (23%) in Era 3; and 1297 (25%) in Era 4. Compared to the CHD WL in eras 1 and 2, those in Era 4 were less likely to be infants (48% vs 49% vs 43%), on mechanical ventilation (30% vs 26% vs 19%), on extracorporeal membrane oxygenation (15% vs 9.7% vs 6.2%), and were more likely to be on a VAD (2.4% vs 2.2% vs 6.0%) (P < .05 for all). WL survival improved in children with CHD from Era 1 to Era 4 (P < .001). However, in Era 4, children with CHD had lower WL survival than those with CMP (P < .001). CONCLUSION: Children with CHD are increasingly being listed with less advanced heart failure, and they have had improved WL survival over time; however, WL outcomes remain inferior to those with CMP. Advances in pediatric medical and VAD therapy may improve future WL outcomes.
BACKGROUND: We evaluated the impact of pediatric heart-allocation policy changes over time and the approval of the Berlin ventricular assist device (VAD) on waitlist (WL) outcomes for children with congenital heart disease (CHD). METHODS: The Scientific Registry of Transplant Recipients database was evaluated to include all children (age < 18) with CHD and cardiomyopathy (CMP) on the WL between 1999 and 2019, divided into 4 eras: Era 1 (1999-2008); Era 2 (2009-2011); Era 3 (2012-2016); and Era 4 (2016-2019). WL characteristics and survival outcomes were evaluated for patients with CHD over time and were compared to those with CMP listed currently (Era 4). RESULTS: We included 5185 children with CHD on the WL during the study period; 1999 (39%) were listed in Era 1; 693 (13%) in Era 2; 1196 (23%) in Era 3; and 1297 (25%) in Era 4. Compared to the CHD WL in eras 1 and 2, those in Era 4 were less likely to be infants (48% vs 49% vs 43%), on mechanical ventilation (30% vs 26% vs 19%), on extracorporeal membrane oxygenation (15% vs 9.7% vs 6.2%), and were more likely to be on a VAD (2.4% vs 2.2% vs 6.0%) (P < .05 for all). WL survival improved in children with CHD from Era 1 to Era 4 (P < .001). However, in Era 4, children with CHD had lower WL survival than those with CMP (P < .001). CONCLUSION: Children with CHD are increasingly being listed with less advanced heart failure, and they have had improved WL survival over time; however, WL outcomes remain inferior to those with CMP. Advances in pediatric medical and VAD therapy may improve future WL outcomes.
Authors: M Mujeeb Zubair; Qiudong Chen; Georgina Rowe; George Gill; Jason Thomas; Shrishiv A Timbalia; Asishana A Osho; Michael E Bowdish; Vikram Sood; Kurt R Schumacher; Joanna Chikwe; Richard W Kim Journal: Circulation Date: 2022-07-18 Impact factor: 39.918