The increasing heart transplant waitlist time for children supported with a ventricular assist device (VAD) has brought into question the impact of support duration on post-transplant outcomes. We sought to analyze the effect of VAD support duration on pre-transplantation condition as well as post-transplantation outcomes in children. Methods: United Network of Organ Sharing (UNOS) database from 2011-2014 had 317 pediatric patients with a long-term VAD implant (≤ 18 y) and support duration data available. Patients were divided into two cohorts based on duration of support (55 days). Fifty-five days was found to be the inflection point of increasing hazard of mortality using cox-proportional hazard model. Results: A total of 135 patients were supported for 55days. Age (7.8±6.4 vs 7.8±6.3; p= 0.67), diagnosis (CHD-15% vs 15%, CMP-78% vs 82%; p= 0.36), use of pulsatile VAD (73% vs 67%; p= 0.23) and incidence of sensitization (39% vs 47%; p= 0.186), was similar between the two groups. Survival was better for patients supported longer (87% vs 95% at 1yr, 81% vs 94% at 3 yrs; p= 0.018) [Figure 1a], even after removing continuous flow VADs. Patients supported longer were more likely to have improvement in pre-transplant condition from listing to transplant. (Figure 1b) The incidence of stroke identified post-transplant (12% vs 4%; p= 0.04) was less in patients supported longer; additionally, post-transplant length of stay (26±23 vs 24±30; p= 0.678), drug treated rejection in 1 st year (15% vs 17%; p= 0.892) and poor functional status at follow up (12% vs 8%; p= 0.360) was similar between the two groups. Conclusion: Longer duration of mechanical support not only improves pre-transplant condition but is also associated with better graft survival and patient outcome. These analyzes may be helpful at a time when changes in pediatric listing policies are being considered.
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