The impact of pre-implant illness severity on the outcomes of pediatric patients undergoing durable ventricular assist device

Arene Butto*, Sarah A. Teele, Lynn A. Sleeper, Philip T. Thrush, Joseph Philip, Minmin Lu, Ryan S. Cantor, Joseph W. Rossano

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Durable ventricular assist devices (VADs) are increasingly used to treat children with heart failure. Studies demonstrate worse outcomes for those in cardiogenic shock at the time of VAD, but limited data exist on less acutely ill children. We describe the association between illness severity and outcomes in this population. METHODS: Data were analyzed from 373 children (aged <19 years) receiving durable VADs from 46 centers in the Pediatric Interagency Registry for Mechanical Circulatory Support. Outcomes were compared by Interagency Registry for Mechanical Circulatory Support (INTERMACS) Patient Profile (PP) and pre-implant characteristics using competing risks methodology. RESULTS: Analyses identified 97 patients in cardiogenic shock (PP 1), 222 with progressive decline (PP 2), and 42 stable on inotropes (PP 3). There were 39 infants, 124 were aged 1 to 9 years and 210 were aged 10 to 19 years. A majority had cardiomyopathy and 66 had congenital heart disease (CHD). There were 224 (62%) continuous-flow VADs. Before implant, 40% received mechanical ventilation (MV). Within 6 months post-implant, 57% underwent transplant and 14% died. PP 1 mortality was highest (25% vs 10% for PP 2, hazard ratio [HR]: 2.5, 95% CI: 1.4–4.4, p = 0.02). In PP 1, CHD was an independent mortality risk factor (HR: 2.9, 95% CI: 1.1–7.8, p = 0.03). In PP 2, pulsatile VADs were associated with death (HR: 3.9, 95% CI: 1.6–9.5, p = 0.003). Patients on MV had high mortality (20%–30%) across PP 1 to PP 3 (HR: 3.0 vs no MV, p < 0.001). CONCLUSIONS: Children in shock at the time of VAD implant have poor outcomes. MV is associated with increased mortality even in lower acuity INTERMACS profiles. Further study is needed to identify modifiable risk factors in this population.

Original languageEnglish (US)
Pages (from-to)666-674
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number7
DOIs
StatePublished - Jul 2020
Externally publishedYes

Keywords

  • cardiomyopathy
  • congenital heart disease
  • heart failure
  • mechanical circulatory support
  • pediatrics
  • ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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