Worldwide Experience of a Durable Centrifugal Flow Pump in Pediatric Patients

The primary objectives of this study were to describe the characteristics and survival outcomes for children supported with the HeartWare HVAD® system from the global community. This was a retrospective survey of patients <18 years of age with an HVAD® system. Questionnaires were sent to sites worldwide in April 2015 and collected between May 2015 and 2016. Information on 205 patients was collected. The median age at implantation was 13.1 years (interquartile range [IQR] 9.8-15.8 years) and the weight was 42 kg (IQR 28-60 kg). Over half of the implants occurred in males (61%), with the most common diagnosis being cardiomyopathy (n = 168, 82%). The majority of HVAD® systems implanted were left ventricular assist device (n = 189, 92.2%). Temporary right ventricular support was utilized in 24 patients (12%) with a median duration of 12 days (6-32 days). Fifty-five percent (n = 111) of the patients were discharged home after implantation after a median (IQR) duration of hospital stay of 40 days (28-71 days). By 12 months, the proportion of patients who underwent heart transplant was 65.4%, 10.7% had died, 3.2% were explanted for recovery, and 20.8% remained on the device. Death on the device on multivariable analysis was associated with the need for temporary RV support (hazard ratio [HR] 10.65 (95% CI 12.53-44.81), P = 0.001) and pump exchange (HR 7.9 (95% CI 1.8-34.2], P = 0.006). The use of the HeartWare HVAD system in the pediatric population is associated with mortality with the majority of patients supported to heart transplant by 1 year post implant. These positive results are independent of geographic location. The need for a temporary right heart support and pump exchange is associated with a higher risk of poor outcomes, and further work is required to predict these patients to allow for optimization. Although survival results are promising, further studies are needed to delineate the associated morbidities with this technology in the pediatric population.