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Published on: May 11, 2018
Use of Intracorporeal Durable LVAD Support in Children Using HVAD or HeartMate 3-A EUROMACS Analysis
Martin Schweiger1,2, Hina Hussein3, Theo M M H de By4
1Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland.
Insights
The HeartMate 3 (HM3) shows excellent outcomes in pediatric patients requiring left ventricular assist device (LVAD) support, with high survival and discharge rates. This study compares HM3 to the HeartWare Ventricular Assist Device (HVAD) in children.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Cardiac Surgery
Background:
- The withdrawal of the HeartWare Ventricular Assist Device (HVAD) in 2021 necessitated alternatives for pediatric patients requiring mechanical circulatory support.
- The HeartMate 3 (HM3) has become a more frequent choice for pediatric left ventricular assist device (LVAD) implantation.
- Comparative outcome data for HVAD versus HM3 in pediatric populations is crucial for clinical decision-making.
Purpose of the Study:
- To analyze and compare the outcomes of pediatric patients (<19 years) supported with either the HVAD or HM3 left ventricular assist device (LVAD).
- To evaluate survival rates, support duration, and adverse events in children receiving these two types of VADs.
- To provide evidence-based insights into the efficacy of HM3 as an alternative to HVAD in pediatric VAD therapy.
Main Methods:
- Retrospective analysis of the EUROMACS database for pediatric VAD patients (age < 19) implanted between January 1, 2009, and December 1, 2021.
- Inclusion criteria focused on patients with LVAD support using either HVAD or HM3, excluding those with missing essential data.
- Kaplan-Meier survival analysis and Fisher's exact test were employed to assess survival differences and other outcomes.
Main Results:
- The study included 150 VAD implantations (128 HVAD, 28 HM3) in 142 pediatric patients.
- Patients receiving HM3 experienced a significantly higher need for temporary right ventricular mechanical support (25% vs. 6%, p=0.01).
- Despite HVAD patients being younger and smaller, overall survival to transplantation, recovery, or ongoing support was high (86%) with no significant difference between groups; 87% of HM3 patients were discharged home.
Conclusions:
- Survival outcomes for pediatric patients implanted with the HeartMate 3 (HM3) left ventricular assist device (LVAD) are excellent.
- A high proportion of pediatric patients supported with HM3 achieved successful discharge, indicating good device performance and patient management.
- HM3 represents a viable and effective option for pediatric mechanical circulatory support following the withdrawal of HVAD.
Abstract:
Purpose: The withdrawal of HVAD in 2021 created a concern for the pediatric population. The alternative implantable centrifugal blood pump HeartMate 3 has since been used more frequently in children. This paper analyses the outcome of children on LVAD support provided with an HVAD or HM3. Methods: A retrospective analysis of the EUROMACS database on children supported with VAD < 19 years of age from 1 January 2009 to 1 December 2021 was conducted. All patients with an LVAD and either an HVAD or HM3 were included. Patients with missing data on VAD status and/or missing baseline and/or follow up information were excluded. Kaplan-Meier survival analysis was performed to evaluate survival differences. Analyses were performed using Fisher's exact test. Results: The study included 150 implantations in 142 patients with 128 implants using an HVAD compared to 28 implants using an HM3. Nine patients (6%) needed temporary right ventricular mechanical support, which was significantly higher in the HM3 group, with 25% (p: 0.01). Patients in the HVAD group were significantly younger (12.7 vs. 14.5 years, p: 0.01), weighed less (45.7 vs. 60 kg, p: <0.000) and had lower BSA values (1.3 vs. 1.6 m2, p: <0.000). Median support time was 204 days. Overall, 98 patients (69%) were discharged and sent home, while 87% were discharged in group HM3 (p: ns). A total of 123 children (86%) survived to transplantation, recovery or are ongoing, without differences between groups. In the HVAD group, 10 patients (8%) died while on support, whereas in 12% of HM3 patients died (p: 0.7). Conclusions: Survival in children implanted with an HM3 was excellent. Almost 90% were discharged and sent home on the device.
