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Impact of mechanical circulatory support on survival in pediatric heart transplantation
Sonia Marcos-Alonso1, Nuria Gil2, Luis García-Guereta3
1Pediatric Cardiology and Congenital Heart Disease Unit, Pediatric Department, Hospital Materno Infantil, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Insights
Mechanical circulatory support (MCS) does not negatively impact pediatric heart transplant survival. However, extracorporeal membrane oxygenation (ECMO) is linked to higher complications and mortality compared to ventricular assist devices (VADs).
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Limited evidence exists on mechanical circulatory support (MCS) impact on pediatric heart transplant (HT) survival, especially for congenital heart disease patients.
- Understanding risk factors for complications in pediatric HT is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the impact of MCS on survival and complications in pediatric patients undergoing urgent heart transplantation.
- To identify risk factors associated with post-transplant outcomes in this population.
Main Methods:
- Retrospective review of urgent pediatric heart transplants (≤16 years) from 2004-2014 using the Spanish Pediatric Heart Transplant Registry.
- Patients were stratified into two groups: urgent with MCS (urgent 0) and urgent without MCS (urgent 1).
- Primary outcome was post-transplant survival; secondary outcomes included complications, infections, and rejection within the first year.
Main Results:
- Out of 121 urgent HTs, 58 used MCS. No significant difference in overall mortality was observed between groups (P=n.s.).
- Patients on ECMO experienced the highest complication (80%) and mortality (40%) rates.
- Patients without MCS (urgent 1) had a higher risk of re-admission for infection (OR 2.31, P=0.025).
Conclusions:
- MCS does not adversely affect overall survival after pediatric heart transplantation.
- Extracorporeal membrane oxygenation (ECMO) is associated with increased mortality and complications compared to ventricular assist devices (VADs).
- Infants, congenital heart disease, and PediMACS were not identified as mortality risk factors.
Abstract:
Evidence on the impact of MCS on pediatric heart transplant survival is still scarce related to congenital heart disease patients including univentricular physiology as well as the risk factors for complications. We performed a retrospective review of all urgent pediatric (aged ≤16 years) HT from 2004 to 2014 in the Spanish Pediatric Heart Transplant Registry Group. Patients were stratified into two groups: urgent 0 (MCS at HT) and urgent 1 (non-MCS at HT). The primary outcome measure was post-transplant survival; secondary outcome measures were complications and absence of infections and rejection during the first post-transplant year. One hundred twenty-one pediatric patients underwent urgent HT, 58 (47.9%) urgent 0 and 63 (52%) urgent 1. There were 30 (24.8%) deaths: 12 in the urgent 0 group and 18 in the urgent 1 group, P = n.s. Regarding the type of MCS, patients on ECMO had the highest rate of complications (80%) and mortality (40%). Patients in the urgent 1 group showed a higher risk of hospital re-admission for infection during the first year after transplantation (OR 2.31 [1.1-4.82]), P = .025. We did not identify a risk factor for mortality. MCS does not impact negatively on survival after HT. However, there is a significant increase in 30-day and 1-year mortality and complications in ECMO patients compared with VAD patients. Infants, congenital heart disease, and PediMACS were not found to be risk factors for mortality.
