Abstract 12276: The Changing Landscape of Ventricular Assist Device Utilization in Children Bridged to Transplant: The “Revolution” Begins

Abstract

Introduction: Growing clinical experience and innovative implantation techniques have allowed individual pediatric centers to push the boundaries of VAD use. However, data describing the global trends in VAD utilization are lacking. We sought to assess temporal trends in the use of VADS as a bridge to transplant in children across the US. Methods: Children <18 years listed for heart transplant 1/2006-6/2014 who were bridged with a VAD were identified in the UNOS database. Patients were stratified by era (Early: 2006-2010, Current: 2011-2014). Descriptive statistics were used to assess trends. Results: Of 3986 patients listed, 589 (15%) received a VAD as bridge to transplant during the study period. The percentage of patients bridged with a VAD increased in the current era (12% vs. 18%, p<0.001), while both durable cfVAD use and waitlist times increased (Table). Children < 25 kg continue to be bridged to transplant almost exclusively with pulsatile devices while 95% of patients ≥ 25 kg were bridged with a cfVAD in 2014 (Figure). Conclusions: The current era has seen a 1.5-fold increase in the percentage of children bridged to transplant with a VAD as well as a 3-fold increase in the percentage of patients bridged with a durable cfVAD in patients > 25 kg. The emergence of cfVAD technology in an era of increasing waitlist times, raises the prospect of a dramatic increase in the number of children discharged from the hospital while supported with a cfVAD. This underscores the need to rapidly define pediatric specific best care practices in outpatient VAD management.