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Rehospitalization Patterns in Pediatric Outpatients with Continuous-Flow VADs
Seth A Hollander1, Sharon Chen, Jenna M Murray
1From the *Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California; †Solid Organ Transplant Services, Lucile Packard Children's Hospital, Stanford, California; and ‡Department of Cardiology, Lucile Packard Children's Hospital, Stanford, California.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|December 24, 2016
Summary
Pediatric patients with continuous-flow ventricular assist devices (CF-VADs) experience rehospitalization, most commonly for infection or pump thrombosis within two weeks of discharge. However, most patients spend significant time out of the hospital between admissions.
Area of Science:
- Pediatric cardiology
- Medical device engineering
- Cardiovascular surgery
Background:
- Continuous-flow ventricular assist devices (CF-VADs) are increasingly used in pediatric patients.
- This trend necessitates understanding outpatient management and rehospitalization patterns in children and adolescents.
Purpose of the Study:
- To analyze the frequency, duration, and indications for rehospitalization in pediatric patients after CF-VAD implantation.
- To evaluate the safety and feasibility of outpatient support for pediatric CF-VAD recipients.
Main Methods:
- Retrospective review of 19 pediatric patients who received CF-VADs and were discharged on device therapy.
- Analysis of hospitalizations between implant discharge and January 8, 2016, focusing on diagnoses and procedures.
Main Results:
- 84% of patients (16/19) were rehospitalized a median of two times over 5,101 follow-up days.
- The median time to first rehospitalization was 14 days.
- Common reasons for admission included suspected infection (28%) and pump thrombosis (17%); 13% required device-related surgery.
Conclusions:
- Pediatric CF-VAD patients can be discharged with acceptable rehospitalization rates and substantial time spent outside the hospital.
- Rehospitalizations are common, often occurring early and primarily due to infection or device thrombosis.
- Device-related complications requiring surgery are more frequent in long-term destination therapy patients.
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