TY - JOUR
T1 - Right heart failure with left ventricular assist device implantation in children
T2 - An analysis of the Pedimacs registry database
AU - Simpson, Kathleen E.
AU - Kirklin, James K.
AU - Cantor, Ryan S.
AU - Mehegan, Mary
AU - Lamour, Jacqueline M.
AU - Guleserian, Kristine J.
AU - Peng, David M.
AU - Pahl, Elfriede
N1 - Publisher Copyright:
© 2019 International Society for Heart and Lung Transplantation
PY - 2020/3
Y1 - 2020/3
N2 - BACKGROUND: The use of ventricular assist device (VAD) in children has increased, but the decision of left VAD (LVAD) vs biventricular support remains a challenge. Children who undergo LVAD placement are at risk for right ventricular failure (RHF), but the incidence has not been described. METHODS: Analysis was performed for patients <18 years old who underwent durable LVAD placement within the Pedimacs registry (September 19, 2012–February 28, 2017), excluding single ventricle morphology and temporary devices. RHF was defined as the need for right ventriculalr assist device (RVAD) or prolonged inotrope use between 1 week to 1 month and 1 to 3 months. End-points included death, heart transplant (HT), and recovery. RESULTS: A total of 272 durable LVAD were placed of which 37 died on device over 24 month follow-up, primarily from multiorgan failure and neurologic dysfunction. RVAD occurred in 12 children at median 8.5 days, with 9 undergoing HT and 3 dying on device. In patients with only LVAD, RHF was present in 111/207 (55%) between 1 week to 1 month and 28/116 (25%) between 1 and 3 months. Younger age, smaller weight, Intermacs profile 1, chemical paralysis, and pulsatile flow VAD were associated with RHF. RHF was associated with increased risk of death on device at both >1 month (hazard ratio 3.2, 95% CI 1.4–7.7, p = 0.007) and >3 month (hazard ratio 6.9, 95% CI 2–23.1, p = 0.002). CONCLUSIONS: In children, RHF is common after durable LVAD implantation, but subsequent RVAD is relatively rare. RHF in children, as indicated by prolonged inotrope support, was associated with an increased risk of death on the device. Whether early RVAD support and higher waitlist status may improve the outcome remains unknown.
AB - BACKGROUND: The use of ventricular assist device (VAD) in children has increased, but the decision of left VAD (LVAD) vs biventricular support remains a challenge. Children who undergo LVAD placement are at risk for right ventricular failure (RHF), but the incidence has not been described. METHODS: Analysis was performed for patients <18 years old who underwent durable LVAD placement within the Pedimacs registry (September 19, 2012–February 28, 2017), excluding single ventricle morphology and temporary devices. RHF was defined as the need for right ventriculalr assist device (RVAD) or prolonged inotrope use between 1 week to 1 month and 1 to 3 months. End-points included death, heart transplant (HT), and recovery. RESULTS: A total of 272 durable LVAD were placed of which 37 died on device over 24 month follow-up, primarily from multiorgan failure and neurologic dysfunction. RVAD occurred in 12 children at median 8.5 days, with 9 undergoing HT and 3 dying on device. In patients with only LVAD, RHF was present in 111/207 (55%) between 1 week to 1 month and 28/116 (25%) between 1 and 3 months. Younger age, smaller weight, Intermacs profile 1, chemical paralysis, and pulsatile flow VAD were associated with RHF. RHF was associated with increased risk of death on device at both >1 month (hazard ratio 3.2, 95% CI 1.4–7.7, p = 0.007) and >3 month (hazard ratio 6.9, 95% CI 2–23.1, p = 0.002). CONCLUSIONS: In children, RHF is common after durable LVAD implantation, but subsequent RVAD is relatively rare. RHF in children, as indicated by prolonged inotrope support, was associated with an increased risk of death on the device. Whether early RVAD support and higher waitlist status may improve the outcome remains unknown.
KW - heart transplant
KW - pediatric
KW - pedimacs
KW - right heart failure
KW - ventricular assist device
UR - http://www.scopus.com/inward/record.url?scp=85077660018&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2019.11.012
DO - 10.1016/j.healun.2019.11.012
M3 - Article
C2 - 31926747
AN - SCOPUS:85077660018
SN - 1053-2498
VL - 39
SP - 231
EP - 240
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 3
ER -