Abstract 3341: The Use of Mechanical Circulatory Support as a Bridge to Transplantation in Pediatric Patients: Excellent Long-Term Survival with Ventricular Assist Devices
BACKGROUND: While successful in adults, the use of mechanical circulatory support (MCS) to bridge pediatric patients to transplantation presents unique challenges due to the difficult anatomic and physiologic conditions in these patients.
METHODS: A review of the UNOS database identified 3,080 status 1A or 1B pediatric (≤18 yrs old) heart transplant recipients from 1995 to 2005. Recipients were stratified into 3 groups; those not requiring pre-transplant MCS (nMCS: n=2,687, 87.2%) and those requiring either extracorporeal membrane oxygenation (ECMO: n=176, 5.7%) or ventricular assist device (VAD: n=217, 7.0%)
RESULTS: ECMO patients were younger (mean age 3.8 yrs) than nMCS or VAD (6.8, 12.4 yrs, p < 0.0001) patients. Long-term post-transplant survival was better in nMCS and VAD patients than in ECMO patients (p<0.0001) (Figure⇓). In-hospital complication rates are shown in Table⇓. Long-term rates of renal failure (9.0 per 100 patient years vs. 4.4, p<0.01), coronary artery disease (5.4 vs. 3.6, p=0.02) were higher among VAD patients.
CONCLUSIONS: Pediatric patients requiring pre-transplant VAD have long-term survival similar to nMCS patients; further analysis of causes of higher rates of long-term morbidity is necessary. Early survival among ECMO patients is poor, reinforcing the need for improvements in device design and physiologic management in infants and neonates patients.