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Updated: May 6, 2026
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
An Examination of Ventricular Assist Device Duration Prior to Heart Transplant in Children
Arene Butto1, Lydia K Wright2, Chad Y Mao3
1Children'S Healthcare of Atlanta, Atlanta, GA, USA. arene.butto@emory.edu.
Insights
Shorter mechanical circulatory support (MCS) device duration before heart transplantation (HTx) in children did not impact survival in an earlier era. This study found no significant difference in one-year post-HTx mortality based on VAD duration.
Area of Science:
- Pediatric cardiology
- Cardiovascular surgery
- Transplantation medicine
Background:
- Previous studies suggest shorter mechanical circulatory support (MCS) device duration correlates with worse heart transplant (HTx) outcomes in children.
- However, these studies did not account for adverse events (AEs) associated with MCS device support.
Purpose of the Study:
- To compare one-year post-HTx mortality in pediatric patients bridged to HTx with less than 30 days versus 30 days or more of MCS device support.
- To assess the impact of MCS device duration on HTx outcomes, considering both device and transplant-related risk factors in an earlier era (2012-2018).
Main Methods:
- Data from the PediMACS and Pediatric Heart Transplant Study registries were merged for 271 pediatric patients.
- Inverse probability of treatment weighting using propensity scores (PS) was employed to control for confounders.
- One-year post-HTx mortality was compared between groups receiving <30 days and ≥30 days of pre-HTx MCS device support.
Main Results:
- Patients receiving <30 days of MCS support at HTx required more mechanical ventilation and vasoactive support.
- The weighted adverse event rate per patient was lower in the <30 days group (0.42) compared to the ≥30 days group (0.78).
- A PS-weighted Cox model, adjusted for 30-day MCS device AEs, showed a non-significant mortality hazard ratio of 0.43 for the <30 days group versus the ≥30 days group.
Conclusions:
- In the era studied (2012-2018), there was no significant difference in one-year post-heart transplant survival based on the duration of mechanical circulatory support device support prior to transplantation.
- Further research is needed to compare these findings with outcomes in the current era of MCS as a bridge to transplantation.
Abstract:
Recent data demonstrate worse heart transplant (HTx) outcomes in children with shorter VAD durations, but do not account for VAD adverse events (AEs)Es. We compared outcomes of patients bridged to HTx with < 30 vs. ≥ 30 days of VAD support in an earlier era by assessing both VAD and HTx risk factors. We merged data from the PediMACS and Pediatric Heart Transplant Study registries to compare one-year post-HTx mortality in patients with < 30 vs. ≥ 30 days of pre-HTx VAD support between 2012 and 2018. We used inverse probability of treatment weighting using propensity scores (PS) to control for confounders, including age, blood type, allosensitization, cardiac diagnosis (cardiomyopathy, congenital heart disease, or myocarditis), VAD support type (left, right, single, or biventricular VAD), and pre-Tx mechanical ventilation and vasoactive support. Among 271 patients, there were 60 in the < 30-days and 211 in the ≥ 30-days groups. At HTx, the < 30-days group used more ventilation (34% vs. 7%, p < 0.001) and vasoactives (60% vs. 24%, p < 0.001 vs. ≥ 30-days). The weighted AE rate/patient was 0.42 in the < 30-days vs. 0.78 in the ≥ 30-days group (p = 0.02). There were 2 deaths in the < 30-days group and 13 in the ≥ 30-days group (p = 0.38). A PS-weighted Cox model, adjusted for 30-day VAD AE rate, demonstrated a non-significant mortality hazard ratio of 0.43 for < 30-days vs. ≥ 30-days group (95%CI 0.07-2.70, p = 0.37). In this era, there was no difference in survival based on VAD duration prior to HTx. This finding requires additional comparisons to the current era of VAD as a bridge to Tx.
