Analysis of UNOS: Ventricular Assist Device as Bridge-to-Transplant in Paediatric Patients With Congenital Heart Disease.

BACKGROUND

In a multi-institutional contemporary cohort of patients < 18 years with congenital heart disease (CHD), we compare outcomes of bridge-to-transplant with and without ventricular assist device (VAD).

METHODS

The United Network for Organ Sharing was queried for all patients <18 years with CHD listed for cardiac transplantation (January 1, 2014, to December 31, 2023). Patients were split into 2 cohorts based on the presence of VAD while on the waitlist. Univariable and multivariable analyses were performed to assess baseline characteristics and post-transplant survival.

RESULTS

The overall patient cohort consisted of 3394 CHD patients listed for cardiac transplantation at 65 centres: 561/3394 = 16.5% had VAD support while on the waitlist and 2833/3394 = 83.5% did not. A total of 396/561 = 70.6% of VAD-supported patients and 1852/2833 = 65.4% of non-VAD-supported patients underwent cardiac transplantation. Waitlist mortality, defined as death or removal from waitlist due to clinical deterioration, was 602/3394 = 17.7% for all patients, 144/561 = 25.7% for VAD-supported patients, and 458/2833 = 16.2% for non-VAD-supported patients. Among the 2248 transplanted CHD patients transplanted at 65 centres (n = 396 VAD-supported, n = 1852 non-VAD-supported), Berlin Heart was the most frequently used VAD (209/396 = 52.8%), and VAD configuration was mostly left ventricular assist device (306/396 = 77.3%). VAD support among CHD patients < 18 bridged-to-transplant increased (20 in 2014, 73 in 2023). VAD-supported patients had similar rates of post-transplant stroke (25/389 = 6.4% vs 83/1835 = 4.5%, P = .145) and episodes of acute rejection (60/396 = 15.2% vs 305/1852 = 16.5%, P = .582) compared to non-VAD-supported patients. No significant differences between VAD-supported and non-VAD-supported patients were seen in longitudinal post-transplant survival up to 5 years (log-rank P = .257).

CONCLUSIONS

In the last decade, patients <18 years with CHD bridged-to transplant with VAD achieve post-transplant outcomes and long-term survival similar to those bridged without VAD.