Functional status of United States children supported with a left ventricular assist device at heart transplantation

Anica Bulic; Katsuhide Maeda; Yulin Zhang; Sharon Chen; Doff B McElhinney; John C Dykes; Amanda M Hollander; Seth A Hollander; Jenna Murray; Olaf Reinhartz; Mary Alice Gowan; David N Rosenthal; Christopher S Almond

doi:10.1016/j.healun.2017.02.024

Functional status of United States children supported with a left ventricular assist device at heart transplantation

J Heart Lung Transplant. 2017 Aug;36(8):890-896. doi: 10.1016/j.healun.2017.02.024. Epub 2017 Mar 2.

Affiliations

¹ Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California; The Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
² The Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
³ Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California; The Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California; The Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
⁴ Department of Rehabilitation Services, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
⁵ Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
⁶ Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California. Electronic address: christopher.almond@stanford.edu.

PMID: 28363739
DOI: 10.1016/j.healun.2017.02.024

Abstract

Background: As survival with pediatric left ventricular assist devices (LVADs) has improved, decisions regarding the optimal support strategy may depend more on quality of life and functional status (FS) rather than mortality alone. Limited data are available regarding the FS of children supported with LVADs. We sought to compare the FS of children supported with LVADs vs vasoactive infusions to inform decision making around support strategies.

Methods: Organ Procurement and Transplant Network data were used to identify all United States children aged between 1 and 21 years at heart transplant (HT) between 2006 and 2015 for dilated cardiomyopathy and supported with an LVAD or vasoactive infusions alone at HT. FS was measured using the 10-point Karnofsky and Lansky scale.

Results: Of 701 children who met the inclusion criteria, 430 (61%) were supported with vasoactive infusions, and 271 (39%) were supported with an LVAD at HT. Children in the LVAD group had higher median FS scores at HT than children in the vasoactive infusion group (6 vs 5, p < 0.001) but lower FS scores at listing (4 vs 6, p < 0.001). The effect persisted regardless of patient location at HT (home, hospital, intensive care) or device type. Discharge by HT occurred in 46% of children in the LVAD group compared with 26% of children in the vasoactive infusion cohort (p = 0.001). Stroke was reported at HT in 3% of children in the LVAD cohort and in 1% in the vasoactive infusion cohort (p = 0.04).

Conclusions: Among children with dilated cardiomyopathy undergoing HT, children supported with LVADs at HT have higher FS than children supported with vasoactive infusions at HT, regardless of device type or hospitalization status. Children supported with LVADs at HT were more likely to be discharged from the hospital but had a higher prevalence of stroke at HT.

Keywords: functional status; heart failure; heart transplant; left ventricular assist device; pediatrics.

MeSH terms

Adolescent
Cardiomyopathy, Dilated / mortality
Cardiomyopathy, Dilated / physiopathology*
Cardiomyopathy, Dilated / surgery
Child
Child, Preschool
Exercise / physiology*
Female
Follow-Up Studies
Heart Transplantation*
Heart-Assist Devices*
Humans
Infant
Male
Quality of Life
Retrospective Studies
Survival Rate / trends
Time Factors
United States / epidemiology
Waiting Lists / mortality
Young Adult