Abstract 10824: Pulsatile Ventricular Assist Device Prior to Pediatric Heart Transplantation is Associated With Favorable Post-Transplant Hemodynamics

Abstract

Background: Ventricular assist device (VAD) support is increasingly used in end-stage pediatric heart failure management. The effects of pulsatile VAD (PVAD) and continuous-flow VAD (CVAD) support on hemodynamics (HDS) after pediatric heart transplant (HT) are unknown. We compared the difference in post-HT HDS between patients supported with PVAD vs CVAD. Methods: We collected measures of pulmonary vascular resistance index (PVRi), cardiac index (CI), and pulmonary wedge pressure (PCWP) in the 1 st year post-HT among patients that underwent HT at our institution between 2013-2020. We defined normal HDS as a PVRi < 3Wu/m 2 , CI > 2.5L/min/m 2 , and PCWP < 12mmHg. Linear regression analysis and Cox regression were performed to compare differences in HDS post-HT. Results: Demographics/clinical features of the patients supported with PVAD (n=18) and CVAD (n=41)are described in Table 1. PVR, CI, and PCWP are plotted in Figure 1. Accounting for confounders, the mean PCWP over the 1 st year is lower in the PVAD group (-0.83 [-1.72-0.07], p=0.07) while the mean CI and mean PVR are similar. In the PVAD cohort, 16 (89%) had normalized HDS in the 1st year vs 17 (42%) in the CVAD group (Log Rank: p<0.001). In multivariate analysis, PVAD was the only variable associated with normalization of HDS (HR 3.87 [1.03-14.52], p=0.045). Compared to our non-VAD cohort (n=97), patients with PVAD were as likely to have HDS normalization by 1 year, but CVAD patients trended towards being less likely to normalize (HR 0.58, p=0.08). Conclusion: Patients supported with PVAD pre-HT have lower PCWP and were more likely to achieve normalization of HDS post-HT compared to patients supported with CVAD.