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Updated: Sep 21, 2026
Implantation of the Syncardia Total Artificial Heart
Published on: July 17, 2014
Functional status of United States children supported with a left ventricular assist device at heart transplantation
Anica Bulic1, Katsuhide Maeda2, Yulin Zhang1
1Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California; The Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
Insights
Pediatric left ventricular assist devices (LVADs) improve functional status in children awaiting heart transplant. While LVAD support offers better functional status and discharge rates, it is associated with a higher risk of stroke.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transplant Medicine
Background:
- Improved survival with pediatric left ventricular assist devices (LVADs) shifts focus to quality of life and functional status (FS).
- Limited data exist on the functional status of children supported by LVADs.
- This study compares FS in children supported by LVADs versus vasoactive infusions.
Purpose of the Study:
- To compare the functional status of children supported with LVADs versus vasoactive infusions.
- To inform decision-making regarding optimal support strategies for pediatric heart failure.
- To evaluate quality of life indicators beyond mortality.
Main Methods:
- Utilized Organ Procurement and Transplant Network data (2006-2015).
- Identified US children (1-21 years) with dilated cardiomyopathy undergoing heart transplant.
- Assessed functional status using the Karnofsky and Lansky scale.
Main Results:
- Children supported with LVADs showed higher FS at heart transplant (6 vs 5, p < 0.001) but lower FS at listing (4 vs 6, p < 0.001).
- LVAD support was associated with higher discharge rates (46% vs 26%, p = 0.001).
- Stroke prevalence was higher in the LVAD group at heart transplant (3% vs 1%, p = 0.04).
Conclusions:
- Pediatric LVAD support is linked to improved functional status at heart transplant compared to vasoactive infusions.
- LVADs facilitate higher hospital discharge rates post-transplant.
- Increased stroke risk is a consideration for pediatric LVAD recipients.
Background:
As survival with pediatric left ventricular assist devices (LVADs) has improved, decisions regarding the optimal support strategy may depend more on quality of life and functional status (FS) rather than mortality alone. Limited data are available regarding the FS of children supported with LVADs. We sought to compare the FS of children supported with LVADs vs vasoactive infusions to inform decision making around support strategies.
Methods:
Organ Procurement and Transplant Network data were used to identify all United States children aged between 1 and 21 years at heart transplant (HT) between 2006 and 2015 for dilated cardiomyopathy and supported with an LVAD or vasoactive infusions alone at HT. FS was measured using the 10-point Karnofsky and Lansky scale.
Results:
Of 701 children who met the inclusion criteria, 430 (61%) were supported with vasoactive infusions, and 271 (39%) were supported with an LVAD at HT. Children in the LVAD group had higher median FS scores at HT than children in the vasoactive infusion group (6 vs 5, p < 0.001) but lower FS scores at listing (4 vs 6, p < 0.001). The effect persisted regardless of patient location at HT (home, hospital, intensive care) or device type. Discharge by HT occurred in 46% of children in the LVAD group compared with 26% of children in the vasoactive infusion cohort (p = 0.001). Stroke was reported at HT in 3% of children in the LVAD cohort and in 1% in the vasoactive infusion cohort (p = 0.04).
Conclusions:
Among children with dilated cardiomyopathy undergoing HT, children supported with LVADs at HT have higher FS than children supported with vasoactive infusions at HT, regardless of device type or hospitalization status. Children supported with LVADs at HT were more likely to be discharged from the hospital but had a higher prevalence of stroke at HT.
