Abstract
Purpose: Pediatric ventricular assist devices (VAD) improve waitlist mortality. We aimed to compare outcomes after heart transplant (HT) based on pre-HT support in patients (pt) <18 years (yr) at listing. Methods: Prospectively collected VAD and post-HT data were linked between ACTION and PHTS databases, respectively (4/1/2018-6/30/2022). Support groups were defined as medical (MG) and VAD (VG), device groups as paracorporeal pulsatile (PP), paracorporeal continuous (PC), and intracorporeal continuous (IC), and device types as LVAD, BiVAD, RVAD, and systemic VAD (SVAD). Standard descriptive statistical methods were used. The Kaplan Meier Method and log rank test analyzed for univariable graft loss post-HT. Results: The 1360 pt included VG=405 and MG=955. At HT, VG pt were younger (6.7 ± 6.2 vs 7.7 ± 6.4 yr; p=0.008) and waited less time for HT 0.35 +/- 0.9 vs 0.5 +/- 0.82 yr (p=0.0036). More VG pt required mechanical ventilation (15.3% vs 11.0% (p=0.03) and intensive care (67% vs 51% p<0.0001). Proportions of congenital heart disease (CHD) and cardiomyopathy (CM) were different between groups (MG: 64.8% CHD and 32.6% CM vs VG: 35.1%CHD and 65.2% CM; p<0.0001). VG device group and type were PP n=184 (LVAD 62.0%, SVAD 22.3%, BiVAD 15.2%), IC n=154 (LVAD 77.3%, SVAD 12.3%, BiVAD 10.4%), PC n=50 (LVAD 26.0%, SVAD 38%, BiVAD 12%), and other n= 17 (41.2% LVAD, 47.0% unknown, 11.8% BiVAD). Overall, graft survival was similar between MG vs VG (p=0.17). There were significant differences in graft survival when stratified by device group ( Figure 1A, IC 95.5%, PP 78.8%, and PC 65.9% p<0.0001), support group and diagnosis ( Figure 1B MG-CM 95.7%, VG-CM 88.0%, MG-CHD 86.5%, and VG-CHD 82.7% at 3 yr, p=<0.0001), and by device type (LVAD 90.3% vs SVAD 80.0, and BiVAD 70.7% at 3yr; p=0.014). Conclusion: Graft survival varies by pre-HT dx and device type and group. CHD, PC, and BiVAD pt may be at higher risk of graft loss. These may be risk factors to consider for risk stratification in post-HT management.
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