Abstract 12217: Ventricular Assist Device (VAD) Support as a Bridge To Pediatric Heart Transplantation: A Practice In Rapid Evolution
Pediatric mechanical support has seen an increase in VAD options and in the variability of their use. We studied the changing spectrum of pediatric VAD use. Data from the Pediatric Heart Transplant Study (1993-2010) were used to study VAD use (n=378) and its impact on outcomes in 4,715 listed & 3,404 transplanted (Tx) patients (pts) <18 y. Subgroup analyses were done for durable (eg. Thoratec brand, Berlin Heart Excor) vs temporary (eg. Abiomed, Centrimag) VADs. At listing, 126 (3%) pts were on VAD support and were older (10.5 vs 5.1y), bigger (BSA 1.3 vs 0.72m2), had cardiomyopathy (63% vs 39%), & less congenital heart disease (18% vs 54%) than non-VAD pts (p<0.0001 for all). VAD use at listing increased with age: <1y, 1%; 1-10y, 2%; & >10y, 6% (p<0.0001). VAD type (mean age & BSA) was Thoratec brand (45%;13.6y;1.6m2), Berlin Heart Excor (27%;5.4y;0.75m2), & Other (28%;10.5y;1.3m2). At Tx, 345 (10%) pts were on VAD support (Fig 1): Berlin Heart Excor (47%;4.7y;0.68m2), Thoratec brand (35%;14.1y;1.6m2), & Other (18%;10.5y;1.3m2). Of the 378 VAD pts, 24% had a VAD at the time of listing and Tx; 67% got a VAD while listed, and 9% had a VAD at the time of listing only. Durable VADs were 84% overall; 64% in VAD at listing only, 85% in both VAD at Tx only and at listing and Tx. Durable (76%) vs temporary (18%) VADs at listing did not vary by age (p=0.52) or era (p=0.9). Overall survival to Tx was 78%; 81% for durable & 68% for temporary (p=0.2). There was no overall survival difference after listing in pts who did or did not have VAD support at listing. Survival at 2y was better post-listing with durable vs temporary VADs (73 vs 42%;p=0.02). There was no overall survival difference post-Tx in pts who did or did not require VAD support regardless of age or durable vs temporary VAD at Tx (p=0.2).
Conclusions: VAD use in children has rapidly increased with equal post-Tx survival to non-VAD children. Most patients got a VAD after listing for Tx. At the time of listing, durable VADs provided a survival advantage over temporary
- © 2012 by American Heart Association, Inc.