CONGENITAL – Original Submission
Analysis of 82 Children Supported With Pulsatile Paracorporeal Ventricular Assist Device: Comparison of Patients With Biventricular Versus Univentricular Circulation

https://doi.org/10.1053/j.semtcvs.2022.05.002Get rights and content

We reviewed outcomes in 82 consecutive children supported with the Berlin Heart pulsatile ventricular assist device (VAD), comparing those with functionally univentricular circulation (n = 34) to those with biventricular circulation (n = 48). The primary outcome was mortality. Kaplan-Meier (KM) methods and log-rank tests were used to assess group differences in long-term survival. T-tests using KM-estimated survival proportions and standard errors were used to compare groups at specific time points. 48 biventricular patients were supported (Age: median = 1.4 years, range = 17 days–17.7 years; Weight [kilograms]: median = 9.4, range = 3.1–112), including 43 BiVAD, 4 LVAD only, and 1 LVAD converted to BiVAD. In biventricular patients, duration of VAD support [days]: median = 97, range = 4–315. Of 48 biventricular patients, 35 underwent heart transplantation, 7 died on VAD, 5 weaned off VAD (1 of whom underwent heart transplantation 334 days after weaning), and 1 is still on VAD. 34 univentricular patients were supported with single VAD (sVAD) (Age: median = 38.5 days, range = 4 days–13.3 years; Weight [kilograms]: median = 3.98, range = 2.4–32.6). In univentricular patients, duration of VAD support [days]: median = 138, range = 4–554. Of 34 univentricular patients, 22 underwent transplantation, 11 died on VAD, and 1 is still on VAD. One-year survival after VAD insertion was 82.7% (95% CI = 72.4–94.4%) in biventricular patients and 59.7% (95% CI = 44.9–79.5%) in univentricular patients, p = 0.026. Five-year survival after VAD insertion was 79.7% (95% CI = 68.6–92.6%) in biventricular patients and 50.5% (95% CI = 35.0–73.0%) in univentricular patients, p = 0.010. Pulsatile VAD facilitates bridge to transplantation in neonates, infants, and children with functionally univentricular circulation; however, survival is worse than in patients with biventricular circulation.

Section snippets

INTRODUCTION

The survival of neonates, infants, children, and adults with congenital heart disease continues to improve after surgical palliation and repair;1,2 however, certain subsets of patients remain at high risk and will ultimately require cardiac transplantation. As the demand for pediatric donor hearts increases, the need for utilizing ventricular assist devices (VADs) as a bridge to transplantation in neonates, infants, and children also increases. Furthermore, as experience with pediatric VADs

Patients

This analysis includes all 82 consecutive patients supported with the Berlin Heart pulsatile VAD at University of Florida, with the first patient cannulated on September 29, 2006 and the most recent patient in this consecutive series cannulated on March 17, 2022. (These 82 patients underwent 83 separate episodes of support with the Berlin Heart because one biventricular child with myocarditis was successfully bridged to transplant, and then 615 days after the original transplant underwent a

RESULTS

Eighty-two consecutive children less than 18 years of age were supported with the Berlin Heart VAD (Age [years]: mean ± SD = 3.44 ± 4.75, median = 191 days, range = 4 days–17.7 years; Weight [kilograms]: mean ± SD = 14.8 ± 19.8, median = 5.75, range = 2.43–112), with the first patient cannulated on September 29, 2006 and the most recent patient cannulated on March 17, 2022. 48 patients with biventricular circulation were supported (43 BiVAD, 4 LVAD only, and 1 LVAD converted to BiVAD) and 34

DISCUSSION

In our single institutional analysis of 82 neonates, infants, and children supported with pulsatile VAD, overall longitudinal Kaplan-Meier estimates for survival after VAD insertion were 73.3% (95% CI = 64.1–83.8%) at one-year and 68.3% (95% CI = 58.4–79.8%) at five-years. One-year survival after VAD insertion was 82.7% (95% CI = 72.4–94.4%) in biventricular patients and 59.7% (95% CI = 44.9–79.5%) in univentricular patients, p = 0.026. Five-year survival after VAD insertion was 79.7% (95%

CONCLUSIONS

Pulsatile VAD facilitates bridge to transplantation in neonates, infants, and children with functionally univentricular circulation; however, survival is worse than in patients with biventricular circulation. One-year survival after VAD insertion was 82.7% (95% CI = 72.4–94.4%) in biventricular patients and 59.7% (95% CI = 44.9–79.5%) in univentricular patients, p = 0.026. Five-year survival after VAD insertion was 79.7% (95% CI = 68.6–92.6%) in biventricular patients and 50.5% (95%

WEBCAST

To view the Webcast of this AATS 102nd Annual Meeting presentation see the URL below: https://www.aats.org/resources/1454.

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  • Cited by (7)

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    Read at the AATS 102nd Annual Meeting, May 14-17, 2022, Boston, MA.

    Presented at The American Association for Thoracic Surgery (AATS) 102nd Annual Meeting. Saturday, May 14, 2022 to Tuesday, May 17, 2022. John B. Hynes Convention Center, Boston, Massachusetts, United States of America. Presented During: Contemporary Transplant and Mechanical Support. Sunday, May 15, 2022: 8:00 AM – 8:15 AM, Hynes Convention Center, Posted Room Name: Room 302.

    Disclosures: Jeffrey P. Jacobs, MD is a Professor of Surgery and Pediatrics at University of Florida and a Consultant for SpecialtyCare.

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