Author + information
- Received November 13, 2017
- Revision received April 20, 2018
- Accepted April 23, 2018
- Published online July 16, 2018.
- Anne I. Dipchand, MDa,∗ (, )@sickkids@UofT,
- Richard Kirk, MDb,
- David C. Naftel, PhDc,
- Elizabeth Pruitt, MSPHc,
- Elizabeth D. Blume, MDd,
- Robert Morrow, MDe,
- David Rosenthal, MDf,
- Scott Auerbach, MDg,
- Marc E. Richmond, MD, MSh,
- James K. Kirklin, MDi,
- for the Pediatric Heart Transplant Study Investigators
- aDepartment of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- bDepartment of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
- cDepartment of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
- dDepartment of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- eDepartment of Pediatrics, Children’s Health System of Texas, Dallas, Texas
- fDepartment of Pediatrics, Stanford University, Palo Alto, California
- gDivision of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
- hDepartment of Pediatrics, Morgan Stanley Children’s Hospital–Columbia University Medical Center, New York, New York
- iDepartment of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
- ↵∗Address for correspondence:
Dr. Anne I. Dipchand, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Background Pediatric ventricular assist device (VAD) use has evolved dramatically over the last 2 decades.
Objectives This study sought to describe the evolution of VAD support to heart transplantation (HTx) in children in a large international multicenter cohort.
Methods Using data from the Pediatric Heart Transplant Study, comparisons were made between children (<18 years) supported to HTx (January 1, 1993 to December 31, 2015) with VAD or extracorporeal membrane oxygenation (ECMO) to VAD support.
Results Of 7,135 listed patients, 5,145 underwent HTx; 995 (19.3%) were supported by a VAD (113 with congenital heart disease [CHD]). Patients with a VAD as their first device (n = 821) were older, larger, and more likely to have cardiomyopathy (80%) than patients transitioned from ECMO to VAD (n = 164). In the VAD-only cohort, 79% underwent HTx and 14% died, compared with 69% and 24% in the ECMO-to-VAD cohort, respectively. Patients with cardiomyopathy achieved HTx 84% of the time, with a 9% waitlist mortality rate compared with 55% and 36%, respectively, for CHD. Among VAD-treated patients, 79% were age >10 years in the earliest era, a percentage decreasing to 34% more recently, though neonates still represent <1%. Overall, survival at 2 and 20 years showed no difference between VAD and no support (2 years: 75% vs. 80%; 20 years: 55% vs. 54%). Post-HTx outcomes were better for durable versus temporary VADs (p < 0.01) and for continuous versus pulsatile VADs (p < 0.01) from 2005 onward; timing of VAD had no impact on post-HTx survival (p = 0.65).
Conclusions For one-quarter of a century, major advances have occurred in mechanical support technology for children, thereby expanding the capability to bridge to HTx without compromising post-HTx outcomes. Significant challenges remain, especially for neonates and patients with CHD, but ongoing innovation portends improved methods of support during the next decade.
Dr. Rosenthal has received research support from Berlin Heart; and has received educational meeting support from HeartWare. Dr. Kirklin has received a stipend as Chair of the data and safety monitoring board for the Xeltis pediatric extracardiac conduit trial; and has received institutional support as principal investigator of the INTERMACS National Mechanical Circulatory Support Registry. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 13, 2017.
- Revision received April 20, 2018.
- Accepted April 23, 2018.
- 2018 American College of Cardiology Foundation
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