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Outcomes and Trends of Ventricular Assist Device Selection in Children with End-Stage Heart Failure

Jacob R Miller1, Timothy S Lancaster, Deirdre J Epstein

  • 1From the *Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri; †Section of Pediatric Cardiology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri; and ‡Section of Pediatric Cardiovascular Surgery, University of Tennessee Health Science Center/LeBonheur Children's Hospital, Memphis, Tennessee.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|December 24, 2016
PubMed

Insights

Continuous flow devices (CFD) are increasingly used over pulsatile flow devices (PFD) in pediatric heart transplant candidates. Survival outcomes were similar between CFD and PFD, despite PFD patients having higher risk factors.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Transplantation Medicine

Background:

  • Ventricular assist devices (VADs) are crucial for pediatric heart failure management.
  • Selection between continuous flow devices (CFD) and pulsatile flow devices (PFD) is critical for eligible pediatric patients.
  • Understanding VAD trends and outcomes is essential for improving pediatric heart transplant (HT) care.

Purpose of the Study:

  • To analyze trends in VAD selection between CFD and PFD in pediatric HT candidates.
  • To compare outcomes associated with CFD versus PFD use in this population.
  • To identify factors influencing device choice and their impact on patient survival.

Main Methods:

  • Retrospective review of the United Network for Organ Sharing database.
  • Inclusion of pediatric patients listed for HT between January 2007 and June 2014.
  • Analysis of patients meeting size eligibility for CFD (BSA > 1.0 m²) and receiving either CFD or PFD.

Main Results:

  • A significant shift towards CFD use was observed, increasing from 11% in 2007 to 88% in 2014.
  • PFD recipients were younger with lower BSA and had higher rates of ECMO and biventricular assist device support.
  • Survival to transplant or recovery (96% vs. 94%) and post-HT survival (95% for both) were similar between CFD and PFD groups.

Conclusions:

  • Despite higher-risk profiles in PFD patients, survival rates were comparable to CFD recipients.
  • There is a marked trend favoring CFD utilization in eligible pediatric patients awaiting heart transplantation.
  • VAD selection strategies should consider patient characteristics and evolving device technology.

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