Abstract 20075: Post-transplant Outcomes for Congenital Heart Disease Patients Bridged to Transplant With Ventricular Assist Deivces
Introduction: Ventricular assist devices (VAD) use as a bridge-to-transplant (BTT) for children of congenital heart disease (CHD) with end-stage heart failure is challenging, yet has been increasingly described. However, its impact on post-transplant outcomes is unknown. This study describes the post-transplant outcomes of CHD patients BTT with a VAD.
Methods: United Network of Organ Sharing database from January 1, 2006 to June 30, 2015 was analyzed for all CHD patients undergoing heart transplantation. Patients were divided into two groups based on VAD use and presence of CHD; +CHD/+VAD and +CHD/-VAD. Pre transplant characteristics and post-transplant outcomes were compared between the groups. +CHD/+VAD post-transplant survival was also compared with -CHD/+VAD and -CHD/-VAD cohorts.
Results: There were 1871 heart transplant recipients who had CHD, 72% (1348) were < 18yo. Median age was 6y [IQR; 0-20y] and 41% (773) were females. One hundred and forty three (7.6%) of CHD heart transplant recipients were BTT with a VAD (+CHD/+VAD). Overtime, there has been a 3-fold increase in VAD utilization for CHD patients undergoing heart transplantation [Figure]. Pre-transplant, +CHD/+VAD compared to +CHD/-VAD had a worse functional status (p=0.004), a higher incidence of dialysis (13% vs 2.5%; p<0.001), infection (29% vs 14%; p=<0.001) and ventilator support (20% vs 13%; p=0.029). Overall, 1y (84% vs 87%) and 5y (72% vs 75%) survival are same for +CHD/+VAD and +CHD/-VAD (p>0.05). Also, 1y and 5y Kaplan-meier survival was not different when comparing +CHD/+VAD with -CHD/+VAD and -CHD/-VAD. [Table]
Conclusion: Although more ill pre-transplant, CHD patients BTT with a VAD have similar post-transplant outcomes compared to CHD patients without a VAD and to other heart transplant patients. Therefore, VAD support in CHD patients may negate certain risk factors for poor post-transplant outcomes in this challenging cohort.
Author Disclosures: R. Rizwan: None. C. Villa: None. F. Zafar: None. D. Wells: None. R. Bryant: None. C. Chin: None. A. Lorts: None. D.L. Morales: Consultant/Advisory Board; Modest; Berlin Heart, HeartWare, SynCardia, Oregon Total Artificial Heart.
- © 2016 by American Heart Association, Inc.