Pediatric Outpatient VAD Experience at Stanford

Abstract

Purpose With recent advances in pediatric ventricular assist devices (VADs), patients are able to be discharged from the hospital. However, the course of outpatient care following outpatient VAD placement is not well described. Methods and Materials We retrospectively reviewed all patients with the Thoratec Heartmate II LVAS (HMII) at our institution between June 2010 and November 2012. Results Seven patients received HMII; patient age ranged from 10 to 18 (mean, 15). All patients had dilated cardiomyopathy; three had an underlying diagnosis of Becker’s muscular dystrophy and one with congenital heart disease. Two patients were transplanted prior to discharge and one patient is currently still hospitalized. Four patients were successfully discharged to the outpatient transition home 1.3 miles away. Average length of stay was 38 days with clinic visits every five days. Once discharged home, patients were seen every one to three months depending on clinical stability. The distance from the implanting center to each patient’s home ranges from 14 to 231 miles away. These four patients have been supported for 87, 583, 169, and 75 outpatient days respectively. There were a total of six re-hospitalizations for rule out infection, rule out hemolysis, post cardiac catherization recovery, knee effusion and rule out hemearthrosis, bilateral pleural effusions, and decompensated cardiogenic shock and multi-system organ failure. Thus far, three patients continue to be supported on outpatient VADs and one is deceased. Conclusions Pediatric VADs can be successfully transitioned to outpatient care even despite distance from implanting center, however, close follow-up and a multidisciplanry highly coordinated approach are absolute requirements.