Analysis of UNOS: Berlin Heart Bridge to Transplant in Acquired vs Congenital Heart Disease.

BACKGROUND

This study evaluated long-term survival in pediatric patients who were bridged to transplantation with the Berlin Heart ventricular assist device by comparing patients with congenital heart disease (CHD) with patients with acquired heart disease (AHD).

METHODS

The United Network for Organ Sharing Database was queried for patients (aged <18 years) who received a heart transplant in the United States and were preoperatively supported with the Berlin Heart ventricular assist device. Patients were stratified by a diagnosis of AHD vs CHD. Univariable and multivariable analyses were performed to assess baseline characteristics and posttransplant survival.

RESULTS

This cohort included 806 patients (n = 573 AHD, n = 233 CHD). Patients with CHD and AHD were of similar size (weight [kg], 12.8 ± 9.27 vs 15.3 ± 13.6; P = .107), and most were aged <1 year (34.9%; n = 281) or 1 to 5 years (45.3%; n = 365). Ventricular assist device configuration differed between patients with CHD and AHD: 70.4% (n = 164) vs 75% (n = 430) were supported with a left ventricular assist device, 9.9% (n = 23) vs 0.7% (n = 4) were supported with a right ventricular assist device, and 19.7% (n = 46) vs 24.3% (n = 139) were supported with a biventricular assist device (P < .001). Patients with CHD were more often male (57.1% [n = 133] vs 46.9% [n = 269]; P = .011), and they had worse estimated 5-year posttransplant survival at 74.3% (95% CI, 67.5%-81.7%) compared with 85.8% (95% CI, 82.5%-89.2%) in patients with AHD. However, for patients who survived the first year after transplantation, posttransplantation survival was similar between the groups (P > .05 at 2, 3, 4, and 5-years). In multivariable analysis, a CHD diagnosis was significantly associated with an increased risk for mortality (hazard ratio, 1.645; 95% CI, 1.075-2.487; P = .021).

CONCLUSIONS

After controlling for demographic variations and pretransplant risk factors, patients with CHD who were bridged to transplant with the Berlin Heart ventricular assist device had worse long-term survival than patients with AHD who were bridged to transplant with the Berlin Heart ventricular assist device.