Pediatric Implantable Ventricular Assist Devices in the State of Texas: A 14 Year Review

Abstract

PurposeThere has been a substantial increase in the use of ventricular assist devices (VAD) in pediatric patients with end-stage heart failure. This study aims to describe the incidence and outcomes of pediatric patients implanted with a VAD using real-world data over the last 14 years.MethodsThis is a retrospective review of the Texas Inpatient Discharge Dataset, an administrative dataset containing most hospital discharges. All discharges of patients <18 years of age between 1/1/2006-12/31/2019 with an ICD-9/10 procedure code consistent with the placement of an implantable VAD were included. Discharges were classified as either congenital heart disease (CHD) or not by the presence of an ICD-9/10 diagnosis code consistent with CHD. Descriptive and univariate statistics were utilized.ResultsA total of 91 pediatric VAD discharges were identified, with 27 (29.7%) having a diagnosis of CHD. The number of pediatric VAD discharges increased from 4 in 2006 to 15 in 2019. Median length of stay was 56 [IQR: 33.5 - 105.5] days, and median duration of support until death, transplant, or discharge was 34 [24 - 63.5] days. There were 8 (8.8%) in-hospital mortalities and 20 (22.0%) heart transplants (HTx) after VAD placement. Discharges with HTx had 0 in-hospital mortalities. Discharges with CHD were associated with neurological complications (33.3% vs. 9.4%, p=0.011), longer length of stay (p=0.023), and longer duration of support (p=0.017) compared to discharges without CHD. (Table).ConclusionPediatric VAD placement as bridge to transplant, bridge to decision, and destination therapy has become more frequent over the last 14 years. This data suggests favorable and comparable short-term outcomes for pediatric VAD patients with and without CHD. Importantly, 91% of patients were able to be discharged with their VAD or after successful bridge to HTx. Further research is needed to understand long-term patient outcomes and further analyze patient risk factors to best improve short and long-term outcomes for this population. There has been a substantial increase in the use of ventricular assist devices (VAD) in pediatric patients with end-stage heart failure. This study aims to describe the incidence and outcomes of pediatric patients implanted with a VAD using real-world data over the last 14 years. This is a retrospective review of the Texas Inpatient Discharge Dataset, an administrative dataset containing most hospital discharges. All discharges of patients <18 years of age between 1/1/2006-12/31/2019 with an ICD-9/10 procedure code consistent with the placement of an implantable VAD were included. Discharges were classified as either congenital heart disease (CHD) or not by the presence of an ICD-9/10 diagnosis code consistent with CHD. Descriptive and univariate statistics were utilized. A total of 91 pediatric VAD discharges were identified, with 27 (29.7%) having a diagnosis of CHD. The number of pediatric VAD discharges increased from 4 in 2006 to 15 in 2019. Median length of stay was 56 [IQR: 33.5 - 105.5] days, and median duration of support until death, transplant, or discharge was 34 [24 - 63.5] days. There were 8 (8.8%) in-hospital mortalities and 20 (22.0%) heart transplants (HTx) after VAD placement. Discharges with HTx had 0 in-hospital mortalities. Discharges with CHD were associated with neurological complications (33.3% vs. 9.4%, p=0.011), longer length of stay (p=0.023), and longer duration of support (p=0.017) compared to discharges without CHD. (Table). Pediatric VAD placement as bridge to transplant, bridge to decision, and destination therapy has become more frequent over the last 14 years. This data suggests favorable and comparable short-term outcomes for pediatric VAD patients with and without CHD. Importantly, 91% of patients were able to be discharged with their VAD or after successful bridge to HTx. Further research is needed to understand long-term patient outcomes and further analyze patient risk factors to best improve short and long-term outcomes for this population.