Abstract 17400: Modern Outcomes of Mechanical Circulatory Support as a Bridge to Pediatric Heart Transplantation
Introduction: Pediatric patients awaiting heart transplantation frequently require bridge to transplantation (BTT) with mechanical circulatory support (MCS). Long-term survival outcomes and predictors of mortality have yet to be described in the modern era using a large-scale analysis.
Hypothesis: We hypothesized that compared to DTXP, children BTT with ECMO would have inferior post-transplant survival.
Methods: The United Network for Organ Sharing database was reviewed to identify pediatric heart transplantation recipients from 2005 through 2012. Patients were stratified into 3 groups: ECMO, VAD or DTXP. The primary outcome was post-transplant survival.
Results: 2,777 pediatric heart transplantation recipients were identified. There were 617 patients BTT with MCS (22.2%), of whom there were 428 VAD BTT (69.4%) and 189 ECMO BTT (30.6%). An increase in VAD use was observed over the study period (P<0.0001). Compared to DTXP, ECMO BTT patients had a lower median age (<1 vs. 5 years, P<0.0001) and were significantly smaller (8 vs.14 kg, p<0.001), while VAD BTT patients were older (8 vs. 5 years, P=0.0002) and larger (24 vs. 14 kg, P<0.001). Actuarial survival was greater in DTXP compared to ECMO BTT, but similar to VAD BTT at 30 days, 1, 3 and 5 years (P<0.0001) (Figure 1). After censoring the first 4 months post-transplant, survival in the ECMO BTT and VAD BTT groups were equivalent to DTXP. In multivariable analysis, ECMO BTT was an independent predictor of post-transplant mortality (HR 2.77, CI 2.12-3.61, P<0.0001), while VAD BTT was not (HR 1.20, CI 0.91-1.58, P=0.15).
Conclusions: Pediatric patients with DTXP or VAD BTT have equivalent post-transplant survival. However, those requiring ECMO BTT have inferior post-transplant survival compared to those receiving DTXP.
- Transplantation/surgical aspects
- Pediatric cardiology
- Ventricular assist devices
- Extracorporeal circulation
Author Disclosures: B. Wehman: None. K. Stafford: None. G. Bittle: None. Z.N. Kon: None. A.C. Watkins: None. N. Pietris: None. O.T. Siddiqui: None. K. Rajagopal: None. S. Pham: None. S. Kaushal: None. B.P. Griffith: None.
- © 2014 by American Heart Association, Inc.