Abstract 12339: Metabolic Response in Children Receiving Ventricular Assist Device Support
Objectives: Ventricular assist devices (VAD) have been increasingly used as a bridge support to heart transplantation (HTx) in children, but its metabolic response remains unknown. C-reactive protein (CRP) and prealbumin (PA) have been used to stratify the metabolic response in children after cardiopulmonary bypass surgery (CPB) including HTx, but not in VAD. We aimed to examine the profiles of CRP and PA in children receiving VAD.
Methods: Charts of 13 children (age ranged 1 month to 17 years, median 11 months) receiving Berlin Heart between 2005 and 2009 were reviewed. Nine patients had left ventricular VAD (LVAD) and 4 had biventricular VAD (BiVAD). The duration of VAD ranged 3-249 days (median 59). CRP and PA were measured twice weekly and recorded prior to and during VAD. White blood cells, doses of inotropes and steroid were recorded. Demographic data included age, weight and CPB time. Data was analyzed by mixed linear regression for repeated measures.
Results: There was 1 death on 25th VAD day. Prior to VAD, CRP was 53±108 mg/L and increased to 95±65 mg/L in day 1-3 after VAD (p=0.01), then decreased to 52±53 mg/L by 1 month (n=8), and to 28±28 mg/L by 4 months (n=5), and to <10 mg/L thereafter (n=4 to 2) (p<0.0001). PA was 0.15±0.05 g/L prior to VAD, and decreased to 0.12±0.05 g/L in day 1-3 after VAD (p=0.04), then gradually increased to 0.14±0.05 g/L by 1 month, and to 0.20±0.08 g/L by 2 months, and maintained stable thereafter (p<0.0001). CRP negatively correlated with lymphocytes (p=0.04), and positively correlated with monocytes (p=0.01) and the doses of epinephrine and norepinephrine (p=0.01 for both). CRP was higher in BiVAD patients than in LVAD patients (p=0.005). PA negatively correlated with norepinephrine doses and CPB time (p=0.05 for both), and positively correlated with age (p=0.05) and the use of steroids (P<0.0001).
Conclusions: Metabolic response is acutely intensified in children after VAD insertion. It appears greater and longer as compared to children after cardiac surgery including HTx as previously reported. The degree of metabolic response is related to the impaired cardiovascular and immune status as well as device type. Clinical management to reduce metabolic response may improve outcomes in children undergoing VAD as well as subsequent HTx.
- © 2010 by American Heart Association, Inc.