Bridge to Transplant with Ventricular Assist Device Support in Pediatric Patients with Single Ventricle Heart Disease

• Published in: ASAIO journal (1992) Vol. 66; no. 2; p. 205
• Main Authors: Chen, Sharon, Rosenthal, David N, Murray, Jenna, Dykes, John C, Almond, Christopher S, Yarlagadda, Vamsi V, Wright, Gail, Navaratnam, Manchula, Reinhartz, Olaf, Maeda, Katsuhide
• Format: Journal Article
• Language: English
• Published: United States 01.02.2020
• Subjects: Child; Child, Preschool; Female; Heart Transplantation; Heart-Assist Devices - adverse effects; Humans; Infant; Male; Retrospective Studies; Time Factors; Treatment Outcome; Univentricular Heart - mortality; Univentricular Heart - therapy
• ISSN: 1538-943X
• DOI: 10.1097/MAT.0000000000000983

Ventricular assist device (VAD) support for children with single ventricle (SV) heart disease remains challenging. We performed a single-center retrospective review of SV patients on VAD support and examined survival to transplant using the Kaplan-Meier method. Patients transplanted were compared with those who died on support. Between 2009 and 2017, there were 14 SV patients with 1,112 patient-days of VAD support. Stages of palliation included pre-Glenn (n = 5), Glenn (n = 5), and Fontan (n = 4). Eight patients (57%) were successfully bridged to transplant at a median 107 days. Deaths occurred early (n = 6, median 16 days) and in smaller patients (10.1 vs. 28.3 kg, P = 0.04). All Fontan patients survived to transplant, whereas only 20% of Glenn patients survived to transplant. Adverse events occurred in 79% (n = 11). Five patients met hospital discharge criteria, with two patients (one pre-Glenn, one Glenn) discharged and transplanted after 219 and 174 days of VAD support. All transplanted patients were discharged at a median 21 days posttransplant. SV patients in various stages of palliation can be successfully bridged to transplant with VAD support. With use of intracorporeal continuous-flow devices, longer-term support and hospital discharge are possible.