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Outcomes of ventricular assist device implantation in children and young adults: the M elbourne experience
Author(s) -
Shi William Y.,
Marasco Silvana F.,
Saxena Pankaj,
d'Udekem Yves,
Yong Matthew S.,
Mitnovetski Sergei,
Brizard Christian P.,
McGiffin David C.,
Weintraub Robert G.,
Konstantinov Igor E.
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13368
Subject(s) - medicine , ventricular assist device , extracorporeal membrane oxygenation , transplantation , stroke (engine) , heart transplantation , cardiomyopathy , surgery , cohort , heart disease , heart failure , young adult , cardiology , mechanical engineering , engineering
Background We evaluated our experience with ventricular assist device ( VAD ) implantation in children and young adults. Methods A total of 64 patients underwent VAD implantation in two centres. The mean age was 15 ± 7.2 years. Thirty‐five (55%) patients were under 18 years of age. Devices implanted included the T horatec P aracorporeal in 30 (47%) patients, B erlin H eart EXCOR in 11 (17%) and VentrAssist in 14 (22%). The diagnosis was cardiomyopathy in 53, congenital heart disease in 11, and graft failure in four patients. Results There were 10 (16%) in‐hospital deaths. Mortality was higher in patients <18 years of age (26% compared with 3.4% for those ≥18 years, P = 0.02). The use of extracorporeal membrane oxygenation prior to VAD implantation was associated with higher mortality ( P = 0.006). Seventeen (27%) patients experienced stroke. Nine patients (14%) required change of VAD because of thrombosis. Transplantation was performed in 44 patients after a mean of 131 ± 141 days on VAD , 11 patients died without transplantation and three patients currently await transplantation. The VAD was explanted in six patients because of recovery. Overall survival from VAD implantation was 69% and 61% at 5 and 10 years, respectively. The 5‐year post‐transplant survival for those bridged with VAD support was 91% and was comparable with a cohort of patients who did not receive a pre‐transplant VAD . Conclusions Children requiring pre‐transplant VAD support have a higher mortality and morbidity compared with young adults. Survival after heart transplantation those supported with VADs was similar to patients of similar age who did not require pre‐transplant support.