Related Experiment Video
Updated: Oct 28, 2025
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
The Effect of Infectious Complications During Ventricular Assist Device Use on Outcomes of Pediatric Heart
Scott R Auerbach1, Ryan S Cantor2, Tamara T Bradford3
1From the Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Insights
Infectious adverse events (IAEs) during ventricular assist device (VAD) support did not significantly impact pediatric heart transplant (HT) outcomes. However, VAD-related IAEs may increase the risk of graft loss and rejection post-transplant.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Infectious Diseases
Background:
- Ventricular assist devices (VADs) are crucial mechanical circulatory support systems for children awaiting heart transplantation (HT).
- Infectious adverse events (IAEs) during VAD support can complicate patient management and potentially affect post-transplant outcomes.
- Understanding the impact of IAEs on graft survival, infection, and rejection is vital for optimizing pediatric HT protocols.
Purpose of the Study:
- To evaluate the association between infectious adverse events (IAEs) occurring during ventricular assist device (VAD) support and subsequent outcomes after pediatric heart transplantation (HT).
- Specifically, to assess the impact of IAEs on graft loss, post-transplant infection, and rejection.
- To differentiate outcomes based on the location of IAEs, including VAD-related infections.
Main Methods:
- A retrospective analysis linking data from the PediatricМеждународный Registry for Mechanical Circulatory Support (Pedimacs) and the Pediatric Heart Transplant Society (PHTS) databases.
- Patients who received a VAD followed by HT between September 2012 and December 2016 were included.
- Patients were stratified into two groups: those with IAEs during VAD support (Group A) and those without (Group B). Outcomes analyzed included graft loss, infection, and rejection using time-dependent analyses (Kaplan-Meier, hazard functions).
Main Results:
- A total of 207 pediatric patients were analyzed, with 42 (20%) experiencing IAEs during VAD support.
- Patients with IAEs on VAD were younger, had longer waiting times for HT, and experienced longer post-HT hospitalizations.
- While overall post-HT freedom from infection, rejection, and graft loss was similar between groups, VAD-related IAEs were associated with a higher likelihood of rejection (p=0.03) and graft loss (p=0.01).
Conclusions:
- Children with IAEs on VAD support who undergo HT tend to be younger, wait longer for transplantation, and have prolonged post-transplant hospital stays.
- Overall, IAEs during VAD support did not significantly alter the long-term outcomes of pediatric heart transplantation.
- However, VAD-related infections represent a specific risk factor that may be linked to increased rates of graft loss and rejection.
Abstract:
To describe the impact of infectious adverse events (IAEs) during ventricular assist device (VAD) support on graft loss, infection, and rejection after pediatric heart transplant (HT). Pedimacs data were linked to Pediatric Heart Transplant Society (PHTS) data for patients receiving a VAD followed by HT between September 2012 and December 2016. Linked patients were categorized into IAE on VAD (group A) and no IAE on VAD (group B). Infectious adverse event locations included nondevice, device (external or internal), and sepsis. Post-HT outcomes for analysis were graft loss, infection, and rejection. Time-dependent analysis included Kaplan-Meier and multiphase parametric hazard function analysis. We linked 207 patients (age 9.4 ± 6.3 years). Post-HT follow-up was 19.4 patient-months (<8 days-4.1 years). Group A included 42 patients (20%) with 62 IAEs. Group B included 165 patients without an IAE. Group A patients were younger (7.4 ± 6.1 vs. 9.5 ± 6.3 years; p = 0.03), waited longer for HT (5.3 ± 4.1 vs. 2.9 ± 2.5 months; p = 0.0005), and were hospitalized longer post-HT (42 ± 59 vs. 23 ± 22 days; p = 0.05). VAD-related IAEs were rare (N = 11). Groups A and B had similar freedom from first post-HT infection, rejection, and graft loss (all p > 0.1). However, patients with VAD-related IAE were somewhat more likely to experience rejection (p = 0.03) and graft loss (p = 0.01). Children with an IAE on VAD who survive to HT are younger, wait longer for HT, and remain hospitalized longer than those without an IAE on VAD. Overall, IAE on VAD did not impact post-HT outcomes, but VAD-related IAE may be associated with graft loss and rejection.
More Related Videos
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:30Pneumonia III: Complications and Assessment
01:25Immunodeficiency Diseases
There are three main causes of immunodeficiency...
01:18Endocarditis III: Medical Management
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...