B-14 | Safety and utility of cardiac catheterization in pediatric patients supported with ventricular assist device (VAD)

With expanded use of ventricular assist device (VAD) support in children, clinical scenarios arise where diagnostic or interventional catheterization may aid management, a principle with proven efficacy in in adult populations. Given marked differences is pediatric heart disease and novelty of such practice in this population, we describe the safety and utility of catheterization for diagnostic and treatment purposes in children supported on VAD. A descriptive retrospective single-center review of cardiac catheterizations performed in children (<19 y) supported on intracorporeal or paracorporeal VADs. VADs were implanted in 67 children from January 2012 to July 2023. Twenty three children (34%) underwent 29 catheterizations while on VAD support. Diagnoses comprised cardiomyopathy (dilated n=9, restrictive n=2), congenital heart disease (n=10, of which 8 had single ventricle anatomy), myocarditis (n=1), and graft vasculopathy (n=1). Indications and interventions included diagnostic (n=13), ramp study (n=11), and primary intervention (n=5). Catheterization was integral to establishing transplant candidacy in 5 patients. Catheterization was performed on baseline therapeutic anticoagulation in all but one case (55% bivalirudin, 20% unfractionated heparin, 13% warfarin, 7% argatroban, 3% apixaban); 79% of catheterizations (n=23) were performed on at least one antiplatelet agent (dual in 2 cases). There was no interruption of antithrombosis therapy for cath. There was no major or clinically relevant bleeding, no pump exchange, and no stroke related to catheterization. Outcomes comprised transplantation (n=14), explantation for recovery (n=2), and death (n=7). Of the 7 patients who died, 5 had single ventricle anatomy, 1 dilated cardiomyopathy and 1 graft vasculopathy. Cardiac catheterization can be safely preformed in pediatric VAD patients without interruption of therapeutic antithrombotic therapy for a variety of indications. Data from these procedures provide invaluable clinical information regarding transplant candidacy, optimal pump parameters and better understanding of hemodynamics similar to that reported in adults.