The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: An analysis of the United Network for Organ Sharing database

Davies, Ryan R.; Russo, Mark J.; Hong, Kimberly N.; O’Byrne, Michael L.; Cork, David P.; Moskowitz, Alan J.; Gelijns, Annetine C.; Mital, Seema; Mosca, Ralph S.; Chen, Jonathan M.

doi:10.1016/j.jtcvs.2007.09.048

Cited by 94 publications

(54 citation statements)

References 13 publications

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“…The use of non-ECLS mechanical cardiac support (such as a VAD) in pediatric patients is associated with waiting-list survival rates similar to those observed in patients classified as United Network for Organ Sharing (UNOS) status 1 who do not require mechanical cardiac support (15). In a study of 431 pediatric patients (<19 years of age), posttransplant survival was better in patients who did not require mechanical cardiac support or who were bridged with VADs as compared with patients who were bridged to transplantation with ECLS (16) (14,15). Waitinglist survival appears to be somewhat better for children supported with newer extracorporeal, pulsatile, VADs, but use of these devices is associated with stroke in approximately 1/3 of patients (17).…”

Section: Ecls Prior To Heart Transplantmentioning

confidence: 86%

“…Posttransplant mortality is greatest during the first 6 months after transplant, and patients who are alive 6 months after transplant appear to have similar survival rates as patients who were not supported with ECLS (13,16). Adults who are bridged with ECLS exhibit similar posttransplant survival curves, with an increased risk of early posttransplant mortality, but long-term survival similar to non-ECLS patients if they survive the initial posttransplant period (1).…”

Section: Ecls Prior To Heart Transplantmentioning

confidence: 99%

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Extracorporeal life support in preoperative and postoperative heart transplant management

Bermúdez

McMullan

2017

Annals of Translational Medicine

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Increased experience with extracorporeal life support (ECLS) as a mode of cardiac support has expanded its use to diverse patient populations including patients requiring a bridge to heart transplantation and patients requiring posttransplant support for primary graft dysfunction (PGD). The use of ECLS is associated with acceptable outcomes in well-selected patients. While outcomes with the use of extracorporeal membrane oxygenation (ECMO) as a bridge to heart transplant have been variable, several series have confirmed the safe use of ECLS to stabilize patients prior to left ventricular assist device (LVAD) implantation. These patients are then considered later, when in stable condition, for heart transplant.When ECLS is used prior to heart transplant, mortality is greatest during the first 6 months posttransplant.Patients who are alive 6 months after transplant appear to have similar survival rates as patients who were not supported with ECLS prior to transplant. ECLS support is a reliable therapeutic option for severe PGD and early graft failure after heart transplantation. In patients who require support for severe PGD, venoarterial-ECMO appears to result in better clinical outcomes than LVAD support. ECLS use for PGD after heart transplant continues to be the first line of support. Further studies are necessary to understand the optimal role of ECLS in heart transplantation.

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Section: Ecls Prior To Heart Transplantmentioning

confidence: 86%

Section: Ecls Prior To Heart Transplantmentioning

confidence: 99%

Extracorporeal life support in preoperative and postoperative heart transplant management

Bermúdez

McMullan

2017

Annals of Translational Medicine

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“…6 -9 Since the introduction of the Berlin Heart EXCOR, a device suitable for smaller children and infants, in 1992, 11,12 VAD support has been used for children of all ages. Recent reports indicate that VAD support was used in 7.1% 9 to 9.5% 13 of pediatric heart transplant candidates at the time of transplantation.…”

mentioning

confidence: 99%

Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)-Defined Morbidity and Mortality Associated With Pediatric Ventricular Assist Device Support at a Single US Center

Stein

Robbins²,

Sabati³

et al. 2010

Circ: Heart Failure

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Background-The use of ventricular assist devices (VADs) to bridge pediatric patients to heart transplantation has increased dramatically over the last 15 years. In this report, we present the largest US single-center report of pediatric VAD use to date. We present detailed descriptions of morbidity and mortality associated with VAD support, using standard Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) criteria for pediatrics to facilitate the comparison of these results to other studies. Methods and Results-We retrospectively identified 25 patients younger than 18 years with 27 episodes of mechanical circulatory support using VADs as bridge to heart transplantation from January 1998 to December 2007. Survival to transplant for the entire cohort was 74%. The most common major morbidities, as defined by INTERMACS criteria for a pediatric population, were respiratory failure, major localized infections, major bleeding events, hepatic dysfunction, and right heart failure. Major neurological events occurred in 48% of the study population. The median time to the first occurrence of an adverse event was less than 14 days for respiratory failure, right heart failure, major localized infection, and major bleeding. Patients who died before transplantation had significantly more adverse events per day of support than did those who were successfully transplanted. Episodes of major bleeding, tamponade, acute renal failure, respiratory failure, and right heart failure were all associated with increased risk of mortality. Conclusions-INTERMACS criteria can be successfully used to analyze pediatric VAD outcomes. These data serve as a baseline for future studies of VAD support in children and indicate good survival rates but considerable morbidity. (Circ Heart Fail. 2010;3:682-688.)

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“…Still, the incidence of such events is relatively high accounting for about 19% of patients and a mortality rate of 65% (Davies et al, 2008, Russo et al, 2009, Thoennissen et al, 2006, and Schmid et al, 1998. It may be hypothesized that cerebral thrombo-embolism may be reduced by adjusting the placement and angle of incidence of the LVAD outflow cannula as well as by the implantation of an aortic-toinnominate artery bypass or an aortic-to-left-carotid artery bypass.…”

Section: Considerations In Adjustment Of Angle Of Incidence In Lvad Imentioning

confidence: 99%

Left Ventricular Assist Devices: Engineering Design Considerations

Simaan¹,

Faragallah²,

Wang³

et al. 2011

New Aspects of Ventricular Assist Devices

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The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: An analysis of the United Network for Organ Sharing database

Cited by 94 publications

References 13 publications

Extracorporeal life support in preoperative and postoperative heart transplant management

Extracorporeal life support in preoperative and postoperative heart transplant management

Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)-Defined Morbidity and Mortality Associated With Pediatric Ventricular Assist Device Support at a Single US Center

Left Ventricular Assist Devices: Engineering Design Considerations

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