Rehospitalization Patterns in Pediatric Outpatients with Continuous-Flow VADs

Abstract

As continuous-flow ventricular assist devices (CF-VADs) are used increasingly in children and adolescents, more pediatric patients will be supported as outpatients. Herein we report the patterns of rehospitalization after CF-VAD implantation at a single center. We retrospectively reviewed the medical records of 19 consecutive patients who received CF-VADs between December 6, 2010 and November 5, 2016 and were discharged on device therapy. The frequency, duration, and indications for all hospitalizations between the time of implant hospitalization discharge and January 8, 2016 were analyzed. There were a total of 52 rehospitalization episodes in 16 (84%) patients over 5,101 (median 93, interquartile range [IQR] 38, 226) follow-up days. There were a median of two (IQR 1, 3) hospitalizations per patient. The median time to first hospitalization was 14 (IQR 7, 62) days. The most common admitting diagnoses were suspected infection 13 (28%) and suspected pump thrombosis in 8 (17%). Thirty-one (60%) hospitalizations included procedures, including seven (13%) requiring device-related surgery. Overall, 89% of postimplant discharge days were spent outside of the hospital. Children with CF-VADs can be discharged with acceptable readmission rates and significant time spent out of hospital. Most patients will be rehospitalized at least once between implant hospitalization and transplantation, often within 2 weeks of hospital discharge, with the most common indications for admission being suspected infection and suspected pump thrombosis. Device-related complications necessitating surgical intervention most frequently occur in destination therapy patients who are supported for longer periods of time.

Pediatric ventricular assist device registries: update and perspectives in the era of miniaturized continuous-flow pumps

“…This is beneficial not only because it allows for physical, nutritional and emotional rehabilitation, but also allows the child to return home with their family. However, even when a patient is well enough to be discharged home, long-term CF-VADs still carry risks of complications (27). The most common complications associated with longterm IC VADs in the pediatric population are bleeding, stroke, infection, pump thrombosis, pump malfunction and RHF (27).…”

“…However, even when a patient is well enough to be discharged home, long-term CF-VADs still carry risks of complications (27). The most common complications associated with longterm IC VADs in the pediatric population are bleeding, stroke, infection, pump thrombosis, pump malfunction and RHF (27). The following will summarize what is known about these complications for long-term CF-VADs.…”

“…A study of pediatric patients implanted with HM3 found that 11% of patients experienced DLI (16). Infections have been associated with the need for re-hospitalization (16) and mortality in the CF-VAD population (10,27). While the EUROMACS registry has not specifically analyzed the data for long term CF-VADs, it has reported that approximately 6% of deaths in VAD patients are due to infection (15).…”

“…[2019] found a device malfunction/pump thrombosis rate of 7% in the early period (<3 months) and 5% in the later period in their study of HVAD in pediatric patients (28). In a combined study of HMII and HVAD pediatric patients, readmission for suspected pump thrombosis made up only 17% of total VAD patients (27). Of those suspected thromboses, 63% were confirmed to have a true pump thrombosis (27).…”

Mechanical circulatory support costs in children bridged to heart transplantation — analysis of a linked database

“…Adults are now routinely discharged following VAD placement 19 and there is increasing experience with this in the pediatric population. 20–22 In fact, 70 patients in our analysis on VAD support were outpatient prior to transplantation. Importantly, this group demonstrated significantly lower total costs compared to patients supported with continuous flow devices that were inpatient at the time of HT.…”