Key result
In-hospital mortality following ventricular assist device implantation was significantly higher in children under 18 years of age compared with young adults (26% vs 3.4%, P=0.02).
Why the study?
What are the clinical outcomes and survival rates of ventricular assist device implantation in children and young adults?
Cohort (n=64)
Yes
What are the clinical outcomes and survival rates of ventricular assist device implantation in children and young adults?
VAD implantation in children and young adults provides a viable bridge to transplantation, though children under 18 face significantly higher mortality and morbidity than young adults.
Answers are grounded in this paper and cite their sources.
Children face higher VAD mortality than young adults; this Level 3 finding leaves open modifiable factors and requires prospective validation before practice change.
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 Thoratec Paracorporeal in 30 (47%) patients, Berlin Heart 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.
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Shi et al. (2015) conducted a cohort in Heart failure requiring ventricular assist device (n=64). Age <18 years vs. Age ≥18 years was evaluated on In-hospital mortality (p=0.02). In-hospital mortality following ventricular assist device implantation was significantly higher in children under 18 years of age compared with young adults (26% vs 3.4%, P=0.02).
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