Transplant Outcomes for Congenital Heart Disease Patients Bridged With a Ventricular Assist Device

Abstract

Ventricular assist device (VAD) use as a bridge to transplant (BTT) for children with end-stage heart failure and congenital heart disease (CHD), although challenging, has increased, but its effect on posttransplant outcome is unknown. This study describes posttransplant outcomes of CHD patients BTT with a VAD. All heart transplant recipients identified in United Network of Organ Sharing database from 2006 to 2015 (n= 21,865) were divided into four groups by those with (+) and without (-) a diagnosis of CHD and with (+) and without (-) VAD support at transplant:+CHD/+VAD,+CHD/-VAD,+VAD/-CHD, and -VAD/-CHD. Posttransplant survival of+CHD/+VAD was compared with+CHD/-VAD, -CHD/+VAD, and -CHD/-VAD in addition to pretransplant characteristics comparison between+CHD/+VAD and+CHD/-VAD. Of 1,871 patients (8.6%) with CHD, 1,348 (72%) were younger than 18 years old, and 143 (7.6%) were BTTwith a VAD (+CHD/+VAD). At transplant, +CHD/+VAD compared with+CHD/-VAD were more likely to have worse functional status (<50%: 60% vs 46%, p= 0.004), infections (29% vs 14%, p < 0.001), to be sensitized (47% vs 30%, p < 0.001) and on ventilator support (20%vs 13%, p= 0.029) and dialysis (13% vs 2.5%, p<0.001). Overall, 1-year (84% vs 87%) and 5-year (72% vs 75%) survival was similar for+CHD/+VAD and+CHD/-VAD (p= 0.694). Survival was also similar when+CHD/+VAD were compared with -CHD/+VAD (n= 7,363; p=0.529) and -CHD/-VAD (n= 12,613; p= 0.097). Although more ill pretransplant, CHD patients BTT with a VAD have similar posttransplant survival compared with CHD patients without a VAD and with other non-CHD heart transplant patients. VAD support may mitigate certain risk factors for poor posttransplant outcomes in the challenging CHD cohort.