doi: 10.1161/CIRCULATIONAHA.105.577601
(Circulation. 2006;113:2313-2319.)
© 2006 American Heart Association, Inc.
Pediatric Cardiology |
Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices
A Multi-Institutional Study
From the Department of Cardiology, Children’s Hospital Boston, Boston, Mass (E.D.B., H.J.B.); Department of Surgery, University of Alabama, Birmingham (D.C.N., J.K.K.); Division of Pediatric and Congenital Heart Surgery, The Children’s Hospital at The Cleveland Clinic, Cleveland, Ohio (B.W.D.); and Division of Pediatric Cardiology, University of Pittsburgh, Children’s Hospital, Pittsburgh, Pa (S.A.W.).
Correspondence to Elizabeth D. Blume, MD, Department of Cardiology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115. E-mail elizabeth.blume{at}cardio.chboston.org
Received July 25, 2005; revision received February 21, 2006; accepted February 24, 2006.
Background— Current ventricular assist devices (VADs) in the United States are designed primarily for adult use. Data on VADs as a bridge to transplantation in children are limited.
Methods and Results— A multi-institutional, prospectively maintained database of outcomes in children after listing for heart transplantation (n=2375) was used to analyze outcomes of VAD patients (n=99, 4%) listed between January 1993 and December 2003. Median age at VAD implantation was 13.3 years (range, 2 days to 17.9 years); diagnoses were cardiomyopathy (78%) and congenital heart disease (22%). Mean duration of support was 57 days (range, 1 to 465 days). Seventy-three percent were supported with a long-term device, with 39% requiring biventricular support. Seventy-seven patients (77%) survived to transplantation, 5 patients were successfully weaned from support and recovered, and 17 patients (17%) died on support. In the recent era (2000 to 2003), successful bridge to transplantation with VAD was achieved in 86% of patients. Peak hazard for death while waiting was the first 2 weeks after VAD placement. Risk factors for death while awaiting a transplant included earlier era of implantation (P=0.05), female gender (P=0.02), and congenital disease diagnosis (P=0.05). There was no difference in 5-year survival after transplantation for patients on VAD at time of transplantation as compared with those not requiring VAD.
Conclusions— VAD support in children successfully bridged 77% of patients to transplantation, with posttransplantation outcomes comparable to those not requiring VAD. These encouraging results emphasize the need to further understand patient selection and to delineate the impact of VAD technology for children.
CLINICAL PERSPECTIVE
Related Article:
- Pediatric Mechanical Circulatory Support: Challenges and Opportunities
- David Rosenthal and Daniel Bernstein
Circulation 2006 113: 2266-2268.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  K. Januszewska, E. Malec, J. Birnbaum, M. Loeff, R. Sodian, C. Schmitz, H. Netz, and B. Reichart Ventricular assist device as a bridge to heart transplantation in children Interactive CardioVascular and Thoracic Surgery, November 1, 2009; 9(5): 807 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. T. Hsu and G. D. Pearson Heart Failure in Children: Part II: Diagnosis, Treatment, and Future Directions Circ Heart Fail, September 1, 2009; 2(5): 490 - 498. [Full Text] [PDF]
|
|
|
|
 |
|
 D. T. Haile and G. J. Schears Optimal Time for Initiating Extracorporeal Membrane Oxygenation Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2009; 13(3): 146 - 153. [Abstract] [PDF]
|
|
|
|
 |
|
 C. S.D. Almond, R. R. Thiagarajan, G. E. Piercey, K. Gauvreau, E. D. Blume, H. J. Bastardi, F. Fynn-Thompson, and T.P. Singh Waiting List Mortality Among Children Listed for Heart Transplantation in the United States Circulation, February 10, 2009; 119(5): 717 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. T. Mahle, G. Ianucci, R. N. Vincent, and K. R. Kanter Costs Associated With Ventricular Assist Device Use in Children Ann. Thorac. Surg., November 1, 2008; 86(5): 1592 - 1597. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. N. Ruygrok, D. S. Esmore, P. M. Alison, K. A. Finucane, S. P. McGuinness, A. D. McGeorge, J. Negri, K. Jones, and H. C. Gibbs Pediatric Experience With the VentrAssist LVAD Ann. Thorac. Surg., August 1, 2008; 86(2): 622 - 626. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Monagle, E. Chalmers, A. Chan, G. deVeber, F. Kirkham, P. Massicotte, and A. D. Michelson Antithrombotic Therapy in Neonates and Children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 887S - 968S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. R. Davies, M. J. Russo, K. N. Hong, M. L. O'Byrne, D. P. Cork, A. J. Moskowitz, A. C. Gelijns, S. Mital, R. S. Mosca, and J. M. Chen The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: an analysis of the United Network for Organ Sharing database. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 421 - 427. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Jones The Year in Cardiovascular Surgery J. Am. Coll. Cardiol., May 8, 2007; 49(18): 1887 - 1898. [Full Text] [PDF]
|
|
|
|
|
|
C. E. Canter, R. E. Shaddy, D. Bernstein, D. T. Hsu, M. R.K. Chrisant, J. K. Kirklin, K. R. Kanter, R. S.D. Higgins, E. D. Blume, D. N. Rosenthal, et al. Indications for Heart Transplantation in Pediatric Heart Disease: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young; the Councils on Clinical Cardiology, Cardiovascular Nursing, and Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group Circulation, February 6, 2007; 115(5): 658 - 676. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Rosenthal and D. Bernstein Pediatric Mechanical Circulatory Support: Challenges and Opportunities Circulation, May 16, 2006; 113(19): 2266 - 2268. [Full Text] [PDF]
|
|