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Outcomes for Children With Congenital Heart Disease Undergoing Ventricular Assist Device Implantation: An ACTION
Shahnawaz Amdani1, Muhammad Farrukh Shezad2, Benjamin Kroslowitz2
1Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
Insights
Children with congenital heart disease (CHD) undergoing ventricular assist device (VAD) implantation face higher adverse event rates and worse survival. Early referral and proactive VAD implantation can improve outcomes for this vulnerable group.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Congenital Heart Disease
Background:
- Limited contemporary data exists on national outcomes for pediatric congenital heart disease (CHD) patients receiving ventricular assist device (VAD) implantation.
- Understanding these outcomes is crucial for improving care for this population.
Purpose of the Study:
- To compare VAD outcomes between pediatric CHD patients and non-CHD patients.
- To evaluate differences in VAD outcomes between univentricular and biventricular CHD patients.
Main Methods:
- Utilized data from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry (April 2018-February 2023).
- Compared preimplantation characteristics, postimplantation survival, and adverse events between CHD and non-CHD cohorts, as well as univentricular and biventricular CHD subgroups.
Main Results:
- Of 966 VAD patients, 352 (36%) had CHD, predominantly univentricular (65%).
- CHD patients were younger, sicker pre-VAD (higher INTERMACS 1, ventilation, TPN, ECMO use), and experienced more major adverse events (stroke, bleeding, infection, organ dysfunction).
- CHD patients had worse adjusted survival (HR: 2.05) compared to non-CHD; no survival difference was found between univentricular and biventricular CHD.
Conclusions:
- Pediatric CHD patients present for VAD implantation in more critical condition, leading to higher adverse event rates and poorer survival.
- Timely referral and proactive VAD implantation are essential to enhance outcomes for children with CHD requiring mechanical circulatory support.
Background:
There are no contemporary reports that highlight the national outcomes for children with congenital heart disease (CHD) undergoing ventricular assist device (VAD) implantation.
Objectives:
This study sought to evaluate differences in VAD outcomes for children with CHD to those with non-CHD as well as those with univentricular CHD to those with biventricular CHD.
Methods:
Data for CHD and non-CHD patients from the multicenter ACTION (Advanced Cardiac Therapies Improving Outcomes Network) undergoing VAD implantation from April 2018 to February 2023 were included. Preimplantation characteristics were compared between CHD and non-CHD as well as univentricular and biventricular CHD patients. Postimplantation survival and adverse events were compared between these cohorts.
Results:
Of 966 patients undergoing VAD implantation, 352 (36%) had CHD, the majority of whom had univentricular CHD (230; 65%). Compared to non-CHD, CHD patients were younger (median age: 1.2 vs 9.4 years), were listed as INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) 1 (36.1% vs 28.7%), were on mechanical ventilation (67.0% vs 44.1%), received total parenteral nutrition (63.6% vs 45.1%), and were on extracorporeal membrane oxygenation (ECMO) preimplantation (33.2% vs 20.5%) (P < 0.05 for all). Except for lower estimated glomerular filtration rate in children with univentricular CHD (median: 47.3 vs 59.9 mL/min/1.73 m2), there were no significant differences in clinical characteristics in univentricular vs biventricular CHD patients. Children with CHD compared to non-CHD were more likely to experience major adverse events (stroke, bleeding, infection, respiratory failure, renal and hepatic dysfunction) and have worse adjusted survival (HR: 2.05; 95% CI: 1.39-3.02; P < 0.001). There were no differences in adjusted survival in univentricular vs biventricular CHD (P > 0.05).
Conclusions:
CHD patients are more likely in extremis at VAD implantation and experience higher rates of adverse events and worse survival compared to those with non-CHD. Timely referral for patients with CHD experiencing worsening heart failure and a proactive approach to VAD implantation has the potential to improve outcomes for this vulnerable cohort.
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