Mechanical circulatory support after paediatric heart transplantation

Area of Science:

• Pediatric Cardiology
• Transplantation Medicine
• Mechanical Circulatory Support

Background:

• Mechanical circulatory support (MCS) is crucial for managing graft failure or rejection post-orthotopic heart transplantation (OHTx) in children.
• Understanding the incidence and outcomes of post-transplant MCS is vital for optimizing patient care.

Purpose of the Study:

• To review the incidence and outcomes of mechanical circulatory support (MCS) in children following orthotopic heart transplantation (OHTx).
• To compare outcomes between early (<1 month) and late (>1 month) post-transplant MCS.
• To evaluate the effectiveness of re-transplantation in pediatric OHTx patients requiring MCS.

Main Methods:

• A retrospective review of pediatric patients (<16 years) undergoing OHTx from 2003 to present.
• MCS was classified as early or late, with support types including veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) and ventricular assist devices (VAD).
• Analysis of 17 episodes of MCS in 15 out of 100 pediatric OHTx patients.

Main Results:

• Fifteen percent (15%) of pediatric OHTx patients required MCS (17 episodes).
• Early graft failure (n=10) had a significantly better survival to discharge (78%) compared to late graft failure (n=6, 50%; P < 0.0001).
• Eight of ten children with early failure were weaned; three of six with late failure died. Re-transplantation had no perioperative deaths.

Conclusions:

• The incidence of post-transplant MCS for graft failure in pediatric OHTx is 15%.
• Early graft failure is associated with better outcomes than late graft failure.
• Re-transplantation offers good mid-term outcomes, and a multimodality MCS strategy improves survival.