Recent Era Outcomes of Mechanical Circulatory Support in Children With Congenital Heart Disease as a Bridge to Heart Transplantation.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
entrez:
25
2
2022
pubmed:
26
2
2022
medline:
22
3
2022
Statut:
ppublish
Résumé
The objective of the study is to compare the clinical characteristics, risk factors, and overall survival (waitlist and posttransplant) outcomes in children with congenital heart disease (CHD) bridged to transplantation with either a ventricular assist device (VAD) versus extracorporeal membrane oxygenation (ECMO) versus no mechanical circulatory support (MCS) in the recent era. The study included 2,899 primary heart transplantations in patients <18 years with CHD between 2010 and 2019 from the United Network Organ Sharing database. Patients who had ECMO or VAD at listing or while listed were included, and their waitlist and posttransplant outcomes were compared with CHD patients who did not require MCS. Of all, 464 (16%) had ECMO and 200 (7%) VAD at the time of or during the listing. The VAD utilization increased over the last decade (4% in 2010 to 10% in 2019, p < 0.01). The 90 days post-MCS survival was better with VAD than ECMO (67 vs. 49%, p < 0.01). The transplantability rate at 90 days was decreased with younger age (odds ratio [OR], 0.91; 95% CI, 0.86-0.95), lower body mass index (BMI) (OR, 0.93; 95% CI, 0.89-0.98) and lower albumin <3g/dl (OR, 0.6; 95% CI, 0.53-0.7). The multivariate model predicted that lower BMI (OR, 1.12; 95% CI, 1.06-1.18), pretransplant ECMO (OR, 2.19; 95% CI, 1.39-3.45), and higher bilirubin (OR, 1.15; 95% CI, 0.97-1.36) decreased 1-year posttransplant survival. Patients transplanted with VAD had better 1-year survival than ECMO (88 vs. 70%, p = 0.01). Waiting list survival of children with CHD supported by VAD is better compared to ECMO. The 1-year posttransplantation outcome of CHD patients supported by VAD is similar to the no MCS patients and better than ECMO-supported patients. There is no significant difference in post-HT survival between patients transitioned from ECMO to VAD while listed and those with VAD-first.
Identifiants
pubmed: 35213887
doi: 10.1097/MAT.0000000000001468
pii: 00002480-202203000-00021
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
432-439Informations de copyright
Copyright © ASAIO 2021.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Rossano JW, Kim JJ, Decker JA, et al.: Prevalence, morbidity, and mortality of heart failure-related hospitalizations in children in the United States: A population-based study. J Card Fail. 18: 459–470, 2012.
Colvin M, Smith JM, Hadley N, et al.: OPTN/SRTR 2017 annual data report: Heart. Am J Transplant. 19(suppl 2): 323–403, 2019.
Dipchand AI, Mahle WT, Tresler M, et al.; Pediatric Heart Transplant Study Investigators: Extracorporeal membrane oxygenation as a bridge to pediatric heart transplantation: Effect on post-listing and post-transplantation outcomes. Circ Heart Fail. 8: 960–969, 2015.
Almond CS, Singh TP, Gauvreau K, et al.: Extracorporeal membrane oxygenation for bridge to heart transplantation among children in the United States: analysis of data from the Organ Procurement and Transplant Network and Extracorporeal Life Support Organization Registry. Circulation. 123: 2975–2984, 2011.
Davies RR, Haldeman S, McCulloch MA, Pizarro C: Ventricular assist devices as a bridge-to-transplant improve early post-transplant outcomes in children. J Heart Lung Transplant. 33: 704–712, 2014.
Blume ED, Rosenthal DN, Rossano JW, et al.; PediMACS Investigators: Outcomes of children implanted with ventricular assist devices in the United States: First analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS). J Heart Lung Transplant. 35: 578–584, 2016.
Wehman B, Stafford KA, Bittle GJ, et al.: Modern outcomes of mechanical circulatory support as a bridge to pediatric heart transplantation. Ann Thorac Surg. 101: 2321–2327, 2016.
Davies RR, Russo MJ, Hong KN, et al.: The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: an analysis of the United Network for Organ Sharing database. J Thorac Cardiovasc Surg. 135: 421–7, 427.e1, 2008.
Peng DM, Koehl DA, Cantor RS, et al.: Outcomes of children with congenital heart disease implanted with ventricular assist devices: An analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs). J Heart Lung Transplant. 38: 420–430, 2019.
Bryant R 3rd, Rizwan R, Villa CR, et al.: Transplant outcomes for congenital heart disease patients bridged with a ventricular assist device. Ann Thorac Surg. 106: 588–594, 2018.
Villa CR, Khan MS, Zafar F, Morales DLS, Lorts A: United States trends in pediatric ventricular assist implantation as bridge to transplantation. ASAIO J. 63: 470–475, 2017.
De Rita F, Hasan A, Haynes S, et al.: Mechanical cardiac support in children with congenital heart disease with intention to bridge to heart transplantation†. Eur J Cardiothorac Surg. 46: 656–62; discussion 662, 2014.
Eghtesady P, Almond CS, Tjossem C, et al.; Berlin Heart Investigators: Post-transplant outcomes of children bridged to transplant with the Berlin Heart EXCOR Pediatric ventricular assist device. Circulation. 128(11 suppl 1): S24–S31, 2013.
Imamura M, Dossey AM, Prodhan P, et al.: Bridge to cardiac transplant in children: Berlin Heart versus extracorporeal membrane oxygenation. Ann Thorac Surg. 87: 1894–1901, 2009.
Rossano JW, Cherikh WS, Chambers DC, et al.: The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-first pediatric heart transplantation report-2018; focus theme: Multiorgan transplantation. J Heart Lung Transplant. 37: 1184–1195, 2018.
Morales DLS, Zafar F, Almond CS, et al.: Berlin Heart EXCOR use in patients with congenital heart disease. J Heart Lung Transplant. 36: 1209–1216, 2017.
Conway J, St Louis J, Morales DLS, Law S, Tjossem C, Humpl T: Delineating survival outcomes in children <10 kg bridged to transplant or recovery with the Berlin Heart EXCOR Ventricular Assist Device. JACC Heart Fail. 3: 70–77, 2015.
Weinstein S, Bello R, Pizarro C, et al.: The use of the Berlin Heart EXCOR in patients with functional single ventricle. J Thorac Cardiovasc Surg. 147: 697–704, 2014.
Almond CS, Morales DL, Blackstone EH, et al.: Berlin Heart EXCOR pediatric ventricular assist device for bridge to heart transplantation in US children. Circulation. 127: 1702–1711, 2013.
Friedland-Little JM, Hong BJ, Gossett JG, et al.: Changes in renal function after left ventricular assist device placement in pediatric patients: A Pedimacs analysis. J Heart Lung Transplant. 37: 1218–1225, 2018.