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Published on: May 11, 2018
Outcomes of Children Supported With Pulsatile Paracorporeal Ventricular Assist Device: Congenital Versus Acquired
Mark S Bleiweis1, Joseph Philip1, Yuriy Stukov1
1Congenital Heart Center, Departments of Surgery, Pediatrics, and Anesthesiology, University of Florida, Gainesville, FL, USA.
Insights
Pediatric patients with congenital heart disease (CHD) show lower survival rates after ventricular assist device (VAD) implantation compared to those with acquired heart disease (AHD). Pulsatile VADs are crucial for bridge-to-transplantation in CHD, but outcomes remain poorer.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Ventricular assist devices (VADs) are used in pediatric patients with end-stage heart failure.
- Comparison of VAD outcomes between congenital heart disease (CHD) and acquired heart disease (AHD) is critical for optimizing treatment strategies.
- This study evaluates the Berlin Heart VAD outcomes in 82 pediatric patients, stratifying by CHD and AHD.
Approach:
- Retrospective review of 82 pediatric patients (<18 years) receiving Berlin Heart VAD support.
- Patients were categorized into congenital heart disease (CHD, n=44) and acquired heart disease (AHD, n=37) groups.
- Kaplan-Meier survival analysis and log-rank tests were employed to compare long-term outcomes.
Key Points:
- One-year survival was significantly lower in CHD patients (59.9%) compared to AHD patients (88.6%) (P=.0004).
- Five-year survival also showed a significant difference, with 55.4% for CHD versus 85.3% for AHD (P=.002).
- While VADs facilitate bridge-to-transplantation in CHD, survival rates remain a significant challenge compared to AHD.
Conclusions:
- Pulsatile VADs are essential for bridge-to-transplantation in pediatric patients with CHD.
- Survival outcomes following VAD insertion are demonstrably worse in children with CHD compared to those with AHD.
- Further research and therapeutic advancements are needed to improve VAD efficacy and long-term survival in pediatric CHD.
Background:
We reviewed the outcomes of 82 consecutive pediatric patients (less than 18 years of age) supported with the Berlin Heart ventricular assist device (VAD), comparing those with congenital heart disease (CHD; n = 44) with those with acquired heart disease (AHD; n = 37).
Methods:
The primary outcome was mortality after VAD insertion. Kaplan-Meier methods and log-rank tests were used to assess group differences in long-term survival.
Results:
Forty-four CHD patients were supported (age: median = 65 days, range = 4 days-13.3 years; weight [kg]: median = 4, range = 2.4-42.3). Ten biventricular CHD patients were supported with eight biventricular assist devices (BiVADs), one left ventricular assist device (LVAD) only, and one LVAD converted to BiVAD, while 34 univentricular CHD patients were supported with single ventricle-ventricular assist devices (sVADs). In CHD patients, duration of VAD support was [days]: median = 134, range = 4-554. Of 44 CHD patients, 28 underwent heart transplantation, 15 died on VAD, and one was still on VAD. Thirty-seven AHD patients were supported (age: median = 1.9 years, range = 27 days-17.7 years; weight [kg]: median = 11, range = 3.1-112), including 34 BiVAD and 3 LVAD. In AHD patients, duration of VAD support was [days]: median = 97, range = 4-315. Of 37 AHD patients, 28 underwent transplantation, three died on VAD, five weaned off VAD (one of whom underwent heart transplantation 334 days after weaning), and one was still on VAD. One-year survival after VAD insertion was 59.9% (95% CI = 46.7%-76.7%) in CHD and 88.6% (95% CI = 78.8%-99.8%) in AHD, P = .0004. Five-year survival after VAD insertion was 55.4% (95% CI = 40.8%-75.2%) in CHD and 85.3% (95% CI = 74.0%-98.2%) in AHD, P = .002.
Conclusions:
Pulsatile VAD facilitates bridge-to-transplantation in neonates, infants, and children with CHD; however, survival after VAD insertion is worse in patients with CHD than in patients with AHD.
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