Characteristics and Outcomes of Pediatric Patients Supported With Ventricular Assist Device—A Multi-Institutional Analysis*

Abstract

Objectives: The use of ventricular assist devices for pediatric patients with heart failure is increasing, but is associated with significant morbidity and mortality. Our objectives were to describe the admission outcomes and resource utilization of pediatric patients supported with ventricular assist devices, utilizing a multicenter database. Data Sources: Pediatric Health Information System database (comprising 49 nonprofit children’s hospitals). Study Selection: Retrospective cohort analysis of the database from January 2006 to September 2015 for all admissions less than or equal to 21 years old with ventricular assist device implantation. Data Extraction: The primary outcome was hospital mortality. The secondary outcomes were hospital length of stay and adjusted cost. Data Synthesis: We analyzed 744 ventricular assist device implantations (740 patients), 422 (57%) males, and 363 (49%) non-Hispanic white. Median age at admission was 5.9 years (interquartile range, 0.9–13.5 yr), and median length of stay was 69 days (interquartile range, 36–122 d). The overall hospital mortality was 188 (25%), whereas 395 (53%) were transplanted and 141 (19%) were discharged on ventricular assist device. Extracorporeal membrane oxygenation was used, in addition to ventricular assist device, in 340 (46%). The majority of ventricular assist device implantations (453, 61%) were from 2011 to 2015 (compared to 2006–2010). More patients discharged on ventricular assist device from 2011 to 2015 (23% vs 13% in 2006–2010; p = 0.001). There was no difference in median age, mortality, length of stay, or adjusted costs between these time periods. On multivariable analysis, underlying congenital heart disease, renal failure, liver congestion, sepsis, cerebrovascular accident, and extracorporeal membrane oxygenation were associated with hospital mortality. Sepsis and ventricular assist device replacement/repair were associated with higher adjusted cost and longer length of stay. Conclusions: The pediatric ventricular assist device experience continues to grow, with a significant increase in the number of patients undergoing ventricular assist device implantation and a higher proportion being discharged from hospital on ventricular assist device support in recent years. Underlying congenital heart disease, renal failure, sepsis, cerebrovascular accident, and extracorporeal membrane oxygenation are significantly associated with hospital mortality.

The Year in Review: Anesthesia for Congenital Heart Disease 2019

“…Patients in the late era were less likely to develop sepsis (28% vs 40%, P ¼ .001), more likely to be discharged home with a VAD (23% vs 13%, P ¼ .001), and less likely to be transplanted during the index VAD admission (48% vs 61%, P ¼ .001). 33 Multivariate analysis demonstrated that CHD, renal failure, liver failure, sepsis, stroke, and ECMO were associated with mortality, while non-Hispanic black race/ethnicity emerged as a significant protective association. There was no difference in cost or LOS between the early and late eras.…”

“…31 Another research study analyzing a large multicenter database was conducted by Puri et al utilizing data from the Pediatric Health Information System (PHIS). 33 This retrospective study analyzed the data on 744 VAD implantations (in patients <21 years of age) from 2006 to 2015 with a primary outcome of hospital morality and secondary outcomes of morbidity and resource utilization. Overall hospital mortality was 25%.…”

“…VAD use is continuing to increase with a relatively stable mortality and complication rate; however, CHD remains a significant risk factor for adverse complications in these patients. 33 An additional study utilizing the Pedimacs and Intermacs database was conducted by VanderPluym et al and compared the outcomes of children versus young adults implanted with the HeartWare (Medtronic, Mounds View, MN) continuous flow VAD (CF-VAD). 34 This device has Food and Drug Administration (FDA) approval for use in adults �18 years old but has increasingly been used children with heart failure as well.…”

Getting more hearts into more kids: Can we do it?

“…Increasingly, data from the United States and elsewhere have shown that many children can be supported with a VAD for an extended period of time with a low morbidity and very low mortality. 3 At present, however, only the Berlin EXCOR is FDA approved for small children. As this device is not approved for discharge from the hospital, smaller children who are supported with durable VADs in the United States, currently must remain in hospital.…”

Arrhythmia Management in Pediatric Patients with Ventricular Assist Devices

“…An increasing number of patients are supported by a VAD, improving survival of patients whether used as destination therapy, bridge to transplantation, or bridge to cardiac function recovery. Over 25,000 VADs have been implanted in the United States [6] and the number of devices implanted in pediatric patients has increased over the years [7][8][9]. Cardiomyopathy, congenital heart disease, and myocarditis are the most frequently encountered underlying conditions in pediatric heart failure patients requiring VAD therapy [10,11].…”