Outcomes of heart transplantation in small children bridged with ventricular assist devices

Arman Kilic, Kristen Nelson, Janet Scheel, William Ravekes, Duke E. Cameron, Luca Vricella

Research output: Contribution to journalArticle

Abstract

Background Ventricular assist devices (VADs) have been used with increasing frequency to bridge small children to heart transplantation (HTx), but outcomes in large cohorts are not well established. Methods Small children (≤ 10 kg) bridged to HTx with VADs between 2004 and 2010 were identified in the United Network for Organ Sharing database. Survival was modeled using the Kaplan-Meier method, and 2:1 propensity matching was used to compare outcomes with a well-matched control cohort of nonbridged HTx recipients. Results Of the 803 small children who underwent HTx during the study period, 59 (7%) were bridged with a VAD. The proportion of recipients that were bridged with a VAD increased from 3% in 2004 to 9% in 2010 (p = 0.03). Kaplan-Meier 30-day, 6-month, and 1-year survival was comparable between those bridged with a VAD and 118 well-matched nonbridged children. Rates of postoperative renal failure, reoperation, infection, and rejection were also comparable. Those bridged with a VAD had a significantly higher rate of postoperative stroke (8.5% vs 0.9%; p = 0.008). Conclusions Small children bridged to HTx with a VAD have early survival rates that are comparable to nonbridged children; however, this is achieved at the expense of a higher rate of stroke. Identifying the risk factors for early death and stroke in small children bridged to HTx with VADs is prudent as more experience with this patient population accumulates.

Original languageEnglish (US)
Pages (from-to)1420-1427
Number of pages8
JournalAnnals of Thoracic Surgery
Volume96
Issue number4
DOIs
StatePublished - Oct 2013

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Heart-Assist Devices
Heart Transplantation
Stroke
Survival
Reoperation
Renal Insufficiency
Survival Rate
Databases
Infection

ASJC Scopus subject areas

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

Cite this

Outcomes of heart transplantation in small children bridged with ventricular assist devices. / Kilic, Arman; Nelson, Kristen; Scheel, Janet; Ravekes, William; Cameron, Duke E.; Vricella, Luca.

In: Annals of Thoracic Surgery, Vol. 96, No. 4, 10.2013, p. 1420-1427.

Research output: Contribution to journalArticle

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abstract = "Background Ventricular assist devices (VADs) have been used with increasing frequency to bridge small children to heart transplantation (HTx), but outcomes in large cohorts are not well established. Methods Small children (≤ 10 kg) bridged to HTx with VADs between 2004 and 2010 were identified in the United Network for Organ Sharing database. Survival was modeled using the Kaplan-Meier method, and 2:1 propensity matching was used to compare outcomes with a well-matched control cohort of nonbridged HTx recipients. Results Of the 803 small children who underwent HTx during the study period, 59 (7{\%}) were bridged with a VAD. The proportion of recipients that were bridged with a VAD increased from 3{\%} in 2004 to 9{\%} in 2010 (p = 0.03). Kaplan-Meier 30-day, 6-month, and 1-year survival was comparable between those bridged with a VAD and 118 well-matched nonbridged children. Rates of postoperative renal failure, reoperation, infection, and rejection were also comparable. Those bridged with a VAD had a significantly higher rate of postoperative stroke (8.5{\%} vs 0.9{\%}; p = 0.008). Conclusions Small children bridged to HTx with a VAD have early survival rates that are comparable to nonbridged children; however, this is achieved at the expense of a higher rate of stroke. Identifying the risk factors for early death and stroke in small children bridged to HTx with VADs is prudent as more experience with this patient population accumulates.",
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AU - Vricella, Luca

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N2 - Background Ventricular assist devices (VADs) have been used with increasing frequency to bridge small children to heart transplantation (HTx), but outcomes in large cohorts are not well established. Methods Small children (≤ 10 kg) bridged to HTx with VADs between 2004 and 2010 were identified in the United Network for Organ Sharing database. Survival was modeled using the Kaplan-Meier method, and 2:1 propensity matching was used to compare outcomes with a well-matched control cohort of nonbridged HTx recipients. Results Of the 803 small children who underwent HTx during the study period, 59 (7%) were bridged with a VAD. The proportion of recipients that were bridged with a VAD increased from 3% in 2004 to 9% in 2010 (p = 0.03). Kaplan-Meier 30-day, 6-month, and 1-year survival was comparable between those bridged with a VAD and 118 well-matched nonbridged children. Rates of postoperative renal failure, reoperation, infection, and rejection were also comparable. Those bridged with a VAD had a significantly higher rate of postoperative stroke (8.5% vs 0.9%; p = 0.008). Conclusions Small children bridged to HTx with a VAD have early survival rates that are comparable to nonbridged children; however, this is achieved at the expense of a higher rate of stroke. Identifying the risk factors for early death and stroke in small children bridged to HTx with VADs is prudent as more experience with this patient population accumulates.

AB - Background Ventricular assist devices (VADs) have been used with increasing frequency to bridge small children to heart transplantation (HTx), but outcomes in large cohorts are not well established. Methods Small children (≤ 10 kg) bridged to HTx with VADs between 2004 and 2010 were identified in the United Network for Organ Sharing database. Survival was modeled using the Kaplan-Meier method, and 2:1 propensity matching was used to compare outcomes with a well-matched control cohort of nonbridged HTx recipients. Results Of the 803 small children who underwent HTx during the study period, 59 (7%) were bridged with a VAD. The proportion of recipients that were bridged with a VAD increased from 3% in 2004 to 9% in 2010 (p = 0.03). Kaplan-Meier 30-day, 6-month, and 1-year survival was comparable between those bridged with a VAD and 118 well-matched nonbridged children. Rates of postoperative renal failure, reoperation, infection, and rejection were also comparable. Those bridged with a VAD had a significantly higher rate of postoperative stroke (8.5% vs 0.9%; p = 0.008). Conclusions Small children bridged to HTx with a VAD have early survival rates that are comparable to nonbridged children; however, this is achieved at the expense of a higher rate of stroke. Identifying the risk factors for early death and stroke in small children bridged to HTx with VADs is prudent as more experience with this patient population accumulates.

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