Outcomes of heart transplantation in small children bridged with ventricular assist devices.

BACKGROUND

Ventricular assist devices (VADs) have been used with increasing frequency to bridge small children to heart transplantation (HTx), but outcomes in large cohorts are not well established.

METHODS

Small children (≤ 10 kg) bridged to HTx with VADs between 2004 and 2010 were identified in the United Network for Organ Sharing database. Survival was modeled using the Kaplan-Meier method, and 2:1 propensity matching was used to compare outcomes with a well-matched control cohort of nonbridged HTx recipients.

RESULTS

Of the 803 small children who underwent HTx during the study period, 59 (7%) were bridged with a VAD. The proportion of recipients that were bridged with a VAD increased from 3% in 2004 to 9% in 2010 (p = 0.03). Kaplan-Meier 30-day, 6-month, and 1-year survival was comparable between those bridged with a VAD and 118 well-matched nonbridged children. Rates of postoperative renal failure, reoperation, infection, and rejection were also comparable. Those bridged with a VAD had a significantly higher rate of postoperative stroke (8.5% vs 0.9%; p = 0.008).

CONCLUSIONS

Small children bridged to HTx with a VAD have early survival rates that are comparable to nonbridged children; however, this is achieved at the expense of a higher rate of stroke. Identifying the risk factors for early death and stroke in small children bridged to HTx with VADs is prudent as more experience with this patient population accumulates.