Durable Ventricular Assist Device Research Articles

(152) - Explantation of Durable Ventricular Assist Device for Myocardial Functional Recovery in Children: A Report from The Action Registry

(152) - Explantation of Durable Ventricular Assist Device for Myocardial Functional Recovery in Children: A Report from The Action Registry

Developments and Challenges in Durable Ventricular Assist Device Technology: A Comprehensive Review with a Focus on Advancements in China.

Heart transplantation is currently the most effective treatment for end-stage heart failure; however, the shortage in donor hearts constrains the undertaking of transplantation. Mechanical circulatory support (MCS) technology has made rapid progress in recent years, providing diverse therapeutic options and alleviating the dilemma of donor heart shortage. The ventricular assist device (VAD), as an important category of MCS, demonstrates promising applications in bridging heart transplantation, destination therapy, and bridge-to-decision. VADs can be categorized as durable VADs (dVADs) and temporary VADs (tVADs), according to the duration of assistance. With the technological advancement and clinical application experience accumulated, VADs have been developed in biocompatible, lightweight, bionic, and intelligent ways. In this review, we summarize the development history of VADs, focusing on the mechanism and application status of dVADs in detail, and further discuss the research progress and use of VADs in China.

Pulmonary Artery Catheter Usage and Impact on Mortality in Patients With Cardiogenic Shock: Results From a Canadian Single-Centre Registry

BackgroundHemodynamic assessment for cardiogenic shock (CS) phenotyping in patients has led to renewed interest in the use of pulmonary artery catheters (PACs). MethodsWe included patients admitted with CS from January 2014 to December 2020 and compared clinical outcomes among patients who received PACs and those who did not. The primary outcome was the rate of in-hospital mortality. Secondary outcomes included use of advanced heart failure therapies and coronary intensive care unit (CICU) and hospital lengths of stay. ResultsA total of 1043 patients were analysed and 47% received PACs. Patients selected for PAC-guided management were younger and had lower left ventricular function. They also had higher use of vasopressor and inotropes, and 15.2% of them were already supported with temporary mechanical circulatory support (MCS). In-hospital mortality was lower in patients who received PACs (29.3% vs 36.2%; P = 0.02), mainly driven by a reduction in mortality among those in Society for Cardiovascular Angiography and Interventions (SCAI) stages D and E CS. Patients who received PACs were more likely to receive temporary MCS with Impella, durable ventricular assist devices (VADs), or orthotopic heart transplantation (OHT) (P < 0.001 for all analyses). CICU and hospital lengths of stay were longer in patients who used PACs. ConclusionsAmong patients with CS, the use of PACs was associated with lower in-hospital mortality, especially among those in SCAI stages D and E. Patients who received PACs were also more frequently rescued with temporary MCS or received advanced heart failure therapies, such as durable VADs or OHT.

Abstract 17254: Myocardial Functional Recovery Following Durable Ventricular Assist Device in Children

Introduction: Ventricular Assist Device (VAD) explantation following myocardial functional recovery (MFR) for heart failure (HF) is uncommon and associated with a risk of recurrence of HF. Research Question: What are the patient characteristics and outcomes for VAD explantation in children following MFR? Methods: Retrospective, single centre study of patients who were supported with durable VADs, both intracorporeal continuous flow devices (CFD) and paracorporeal pulsatile flow devices (PFD) between 2004 to 2022. Results: A total of 75 children, of which 43 were female, underwent VAD implantation (PFD = 61 and CFD = 14) at a median (IQR) age of 5.6 (0.8, 13.5) years and with a weight of 16.2 (7.5, 40.7) kg. From this cohort, we identified 8/75 (11%) children who underwent VAD explantation for MFR after a median duration of 56 (22, 115) days. All were supported with durable PFD. Five were listed for transplantation as a part of their HF management strategy following VAD implantation and four patients had dilated cardiomyopathy (DCM). Of those, 7/8 (88%) children with MFR were under 2 years of age and 5/8 (63%) were supported for &gt; 90 days. The pathological findings on the LV core samples were variable in severity and no patient had any evidence of active inflammation (see Table). After explant, 7/8 patients remained in HF remission with no symptoms and stable LV function. One patient had a recurrence of HF following explantation after demonstrating MFR while on VAD support. This patient was 5 years old at implant and was in HF remission for ~9 months following explant before HF recurrence, requiring VAD re-implantation and eventual heart transplantation. Conclusions: MFR resulting in VAD explantation is feasible in children with chronic HF especially for those &lt; 2 years of age. Further work is needed to help better identify the features that promote MFR and maintain it after explant.

Abstract 18247: Society for Cardiovascular Angiography and Intervention Shock Staging is Associated With Outcomes in Patients With an Impella 5.5 Temporary Left Ventricular Assist Device

Introduction: Surgically implanted microaxial ventricular assist devices (VAD) such as Impella 5.5 are increasingly used as temporary mechanical circulatory support (tMCS) in patients at risk for and with cardiogenic shock (CS). Understanding the associations between CS severity and outcomes in patients supported with Impella 5.5 may optimize patient selection and prevent futile interventions. Hypothesis: Increasingly severe Society for Cardiovascular Angiography and Intervention (SCAI) SHOCK stages in patients supported with Impella 5.5 are associated with worse outcomes. Methods: From 2019-2022, retrospective review of perioperative characteristics, SCAI SHOCK stage and outcomes in patients supported with an Impella 5.5. Results: In total, 228 Impella 5.5s were implanted in 226 patients; 28% (63) SCAI SHOCK stage A, 4% (10) stage B, 14% (31) stage C, 46% (104) stage D and 9% (20) stage E. Stage A and B patients more often had elective Impella 5.5s for tMCS-assisted interventions (cardiac surgery, PCI, VT ablation) (30%, 69/228) while stage C-E patients primarily had Impella 5.5 placement for acute MI (AMI), chronic cardiomyopathy and postcardiotomy CS (60%, 136/228) (p&lt;0.01). Death on Impella support by SCAI SHOCK stage was: A 3.2%, B 10%, C 13%, D 27%, E 37% (p&lt;0.01). The transition to durable VAD or heart transplant by SCAI SHOCK stage was: A 1.6%, B 0%, C 48%, D 35%, E 16% (p&lt;0.01). Conclusions: Patients supported with Impella 5.5s presented in varying degrees of CS as defined by SCAI SHOCK stage. Patients with AMI, chronic cardiomyopathy, and postcardiotomy CS more commonly presented in higher SCAI SHOCK stages than those who underwent planned Impella 5.5-assisted cardiac interventions. Patients in stage E at implant had the highest mortality while patients in stage C and D were more likely to be bridged to durable VAD or heart transplant.

Predicting Outcomes Following Short-Term Ventricular Assist Device Implant with the MELD-XI Score.

Short-term continuous flow (STCF) ventricular assist devices (VADs) are utilized in adults with cardiogenic shock, however, mortality remains high. Previous studies have found that high pre-operative MELD-XI scores in durable VAD patients is associated with mortality. The use of the MELD-XI score to predict outcomes in STCF-VAD patients has not been explored. We sought to determine the relationship between MELD-XI and outcomes in adults with STCF-VADs. This was a retrospective review of adults implanted with STCF-VADs between 2009-19. Receiver operating characteristic (ROC) analysis was performed to predict outcomes and Kaplan-Meier analysis was done to assess survival. Seventy-nine patients were included with a median MELD-XI score of 21.2 (IQR 13.5, 27.0). Patients with an unsuccessful wean from support (p<0.001) or major post-operative bleeding (p=0.03) had significantly higher pre-implant MELD-XI scores. The optimal MELD-XI cut-point for mortality was 24.9 with 27.8 for major bleeding. Survival was worse among patients in the high-risk MELD-XI group, however, not statistically significant (p=0.09). Prior ECMO support, but not MELD-XI, was an independent predictor of unsuccessful wean (p=0.03). Pre-operative MELD-XI score was a moderate predictor of unsuccessful wean with limited utility in predicting bleeding in patients on STCF-VAD support. This scoring system may be useful in the clinical setting for pre-implant risk stratification and counselling among patients and outcomes.

Supporting univentricular heart in biventricular circulation

I read with great interest a recent report of Bleiweis and colleagues1 on ventricular assist device (VAD) support in neonates and infants with a failing univentricular circulation. Neonates and infants with failing univentricular circulation might be listed for urgent heart transplantation after initial palliative surgery. Furthermore, a subgroup of high-risk patients with univentricular circulation might be best served with primary transplantation. Because the donor hearts are not readily available for these challenging patients, durable VAD support as bridge to heart transplantation is often the only alternative to death.

Waitlist Status And Outcomes After Heart Transplantation Under The New Heart Allocation System For Adults With Pre-transplant Durable Ventricular Assist Devices: A Unos Registry Analysis

Waitlist Status And Outcomes After Heart Transplantation Under The New Heart Allocation System For Adults With Pre-transplant Durable Ventricular Assist Devices: A Unos Registry Analysis

(334) Outcomes and Quality of Life in Patients Receiving Durable Ventricular Assist Device Therapy with Bivad Support

(334) Outcomes and Quality of Life in Patients Receiving Durable Ventricular Assist Device Therapy with Bivad Support

Impact of 2016 UNOS pediatric heart allocation policy changes on VAD utilization, waitlist, and post-transplant survival outcomes in children with CHD versus Non-CHD.

We analyzed the impact of the revised pediatric heart allocation policy on types of ventricular assist device (VAD) utilization, and waitlist (WL) and post-heart transplant (HT) survival outcomes in congenital heart disease (CHD) versus non-CHD patients before (Era-1) and after (Era-2) pediatric heart allocation policy implementation. We retrospectively reviewed the UNOS database from December 16, 2011, through March 31, 2021, for patients<18 years old and listed for primary HT. We compared the differences observed between Era-1 and Era-2. 5551 patients were listed for HT, of whom 2447(44%) were in Era-1 and 3104(56%) were in Era-2. CHD patients were listed as status 1A unchanged, but the number of patients listed as status 1B decreased in Era-2, whereas the number of non-CHD patients listed as status 1A decreased, but status 1B increased. In Era-2 compared to Era-1, both temporary (1% to 4%, p<.001) and durable VAD (13.6% to 17.8%, p<.001) utilization increased, and the transplantation rate per 100-patient years increased in both groups. The median WL period for CHD patients increased marginally from 70 to 71 days (p=.06), whereas for non-CHD patients it decreased from 61 to 54 days (p<.001). Adjusted 90-day WL survival increased from 84% to 88%, p=.016 in CHD, but there was no significant change in non-CHD patients (p=.57). There was no significant difference in 1-year post-HT survival in CHD and non-CHD patients between Era-1 and Era-2. In summary, after the revised heart allocation policy implementation, temporary and durable VAD support increased, HT rate increased, waitlist duration marginally increased in the CHD cohort and decreased in the non-CHD cohort, and 90-day WL survival probability improved in children with CHD without significant change in 1-year post-HT outcomes. Future studies are needed to identify changes to the policy that may further improve the listing criteria to improve WL duration and post-HT survival.

Ventricular assist device support for failing Glenn circulation: Impact of concomitant Fontan completion in select patients

Ventricular assist device (VAD) support for failing Glenn circulation represents a unique challenge. We conducted a retrospective review of clinical outcomes in patients with VAD support for failing Glenn circulation between 2010 and 2020 at a tertiary pediatric institution. Ten patients were included: INTERMACS profiles were 1 in 3 patients and 2 in 7 patients. The median age, weight, and body surface area were 3.2 years, 13.0 kg, and 0.5 m2, respectively. Seven patients (70%) were implanted with continuous-flow devices and 3 with para-corporeal devices. Nine patients (90%) received heart transplant, with a median support duration of 77 days. Four (67%) out of 6 patients supported with discharge-capable devices were managed as outpatients. Post-transplant survival was 100%, with a median (range) follow up duration of 3.5 (1.8-11.9) years. There were 3 neurologic complications in 3 patients (0.9 events per patient-year); 2 intraoperative events (fatal hypoxia and symptomatic embolic stroke) and 1 postoperative (asymptomatic subarachnoid hemorrhage). Pump thrombosis occurred in one patient (0.3 events per patient-year), requiring pump exchange at day 65. Five patients (50%) received concomitant Fontan completion (fenestrated in 1). The Fontan-upgraded patients (vs Glenn) tended to be larger (median (range): 15.9 (12.6-22.9) vs 9.1 (7.7-22.8) kg), older (4.7 (3.1-6.5) vs 1.1 (0.9-10.1) years) and had a higher PaO2/FiO2 ratio (192 (52-336) vs 76 (59-78) mm Hg) on postoperative day 1. Our experience suggests the feasibility of durable VAD support for failing Glenn circulation. Concomitant Fontan completion may be considered in select patients to improve oxygen delivery.

Care fragmentation predicts 90-day durable ventricular assist device outcomes.

To examine whether fragmentation of care is associated with worse in-hospital and 90-day outcomes following durable ventricular assist device (VAD) implant. Cohort study. This study was conducted using Medicare claims linked to the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) among patients undergoing VAD implant between July 2009 and April 2017. Medicare data were used to measure fragmentation of the multidisciplinary care delivery network for the treating hospital, based on providers' history of shared patients within the previous year. STS Intermacs data were used for risk adjustment and outcomes ascertainment. Hospitals were sorted into terciles based on the degree of network fragmentation, measured as the mean number of links separating providers in the network. Multivariable regression was used to associate network fragmentation with 90-day death or infection risk. The cohort included 5159 patients who underwent VAD implant, with 11.2% dying and 27.6% experiencing an infection within 90 days after implant. After adjustment, a 1-unit increase in network fragmentation was associated with an increase of 0.179 in the probability of in-hospital infection and an increase of 0.183 in the probability of 90-day infection (both P < .05). Similar results were observed in models of the numbers of in-hospital and 90-day infections. Network fragmentation was predictive of the probability of 90-day mortality, although this relationship was not significant after adjustment. Care delivery network fragmentation is associated with higher in-hospital and 90-day infection rates following durable VAD implant. These networks may serve as novel targets for enhancing outcomes for patients undergoing VAD implant.

Transinnominate Impella 5.5 insertion as a bridge to transplantation in a pediatric patient in refractory cardiogenic shock.

Transinnominate Impella 5.5 insertion as a bridge to transplantation in a pediatric patient in refractory cardiogenic shock.

Impact of Temporary Preoperative Mechanical Support on Heart Transplant Outcomes.

We sought to assess the impact of temporary preoperative mechanical circulatory support (TPMCS) on heart transplantation outcomes. A total of 4,060 adult heart transplants from June 1, 2006, to December 31, 2019, were identified in the Scientific Registry of Transplant Recipients database as having TPMCS. Recipients were divided into groups based on their type of TPMCS: intra-aortic balloon pump (IABP), temporary ventricular assist device (VAD), biventricular assist device (BIVAD), and extracorporeal membrane oxygenation (ECMO). Perioperative outcomes and survival were compared among groups. Recipients with IABP were associated with older age, a smoking history, and a significantly shorter wait list time ( p < 0.01). Recipients with ECMO had a significantly increased in-hospital mortality as well as an increased incidence of dialysis ( p < 0.01). Kaplan-Meier analysis revealed worse 1 and 5 year survival for recipients with ECMO. Cox model demonstrated a significantly increased risk of mortality with BIVAD (hazard ratio [HR], 1.33; 95% CI, 1.12-1.57; p < 0.01) and ECMO (HR, 1.64; 95% CI, 1.33-2.03; p < 0.01). While patients with IABP have a survival comparable to patients without TPMCS or durable left VAD, outcomes for BIVADs and ECMO are not as favorable. Transplantation centers must continue to make careful choices about the type of TPMCS utilized before heart transplant.

Decreasing driveline infections in patients supported on ventricular assist devices: a care pathway approach

BackgroundDriveline infections (DLIs) are a common adverse event in patients on ventricular assist devices (VADs) with incidence ranging from 14% to 59%. DLIs have an impact on patients and the...

Ventricular assist device support for children with chemotherapy-induced cardiomyopathy and advanced heart failure: Perspectives gained from a single-center experience.

Guidance and data on ventricular assist device (VAD) support for children with chemotherapy-induced cardiomyopathy, particularly within the first 2years after chemotherapy, are limited. We performed a single-center retrospective case series, reviewing medical records of children <18years of age with chemotherapy-induced cardiomyopathy and advanced heart failure (HF) who received durable VAD support. Six patients met inclusion criteria-5 HeartWare™ HVAD, 1 Berlin Heart EXCOR® . Median age at cancer diagnosis was 6years (IQR 4.5-10years). Median dose of anthracycline received was 540mg/m2 (IQR 450-630mg/m2 ). All patients developed HF within 1year after initiation of cancer treatment (median 8months, IQR 6-11.5months) and were initiated on durable VAD support at a median of 8months after completion of cancer treatment (IQR 3.3-43.5months). Four patients had significant right ventricular dysfunction needing oral pulmonary vasodilator therapy, one patient had a major bleeding complication, and two patients had thromboembolic strokes while on VAD support. Median duration of VAD support was 7.5months (IQR 3-11.3months). Two patients underwent VAD explant due to recovery of LV function, one died due to cancer progression, and three underwent heart transplantation. Durable VAD support should be considered as a therapeutic option for children who have advanced HF due to chemotherapy-induced cardiomyopathy, even within 2years of completing cancer treatment. A multi-disciplinary approach is essential for appropriate patient selection prior to implant and to ensure comprehensive care throughout the duration of VAD support.

Trends in Contemporary Use of Ventricular Assist Devices in Children Awaiting Heart Transplantation and Their Outcomes by Race/Ethnicity.

This retrospective study included children aged ≤18 years who had durable ventricular assist devices (VADs) as a bridge to transplantation from the United Network Organ Sharing (UNOS) database between 2011 and 2020. We evaluated 90 day waitlist mortality and 1 year posttransplant mortality after VAD implantation in children stratified by race/ethnicity: Black, White, and Others. The VAD was used in a higher proportion of Black children listed for heart transplantation (HT) (26%) versus Other (25%) versus White (22%); p < 0.01. Black children had Medicaid health insurance coverage (67%) predominantly at the time of listing for HT. There was no significant overall difference in waitlist survival among the three groups supported with VAD at the time of listing (log-rank p = 0.4). On the other hand, the 90 day waitlist mortality after the VAD implantation at listing and while listed was the lowest among Black (6%) compared with White (13%) and Other (14%) ( p < 0.01). The multivariate regression analysis showed that Other race (hazard ratio [HR], 2.29; p < 0.01), Black race (HR, 2.13; p < 0.01), use of mechanical ventilation (HR, 1.72; p = 0.01), and Medicaid insurance (HR, 1.54; p = 0.04) were independently associated with increased 1 year posttransplant mortality. In conclusion, Black children had more access to durable VAD support than White children. The 90 day waitlist mortality was significantly lower in Black children compared with White and Other after VAD implantation. However, Black and Other racial/ethnic children with VAD at transplant had higher 1 year posttransplant mortality than White children. Future studies to elucidate the reasons for these disparities are needed.

Excellent Long-Term Survival After Weaning from Durable Ventricular Assist Device

<h3>Purpose</h3> It is reported that bridge to recovery was achieved in a limited number of cases after durable ventricular assist device (VAD). Thus, long-term survival over 5 years after removal of the device is not thoroughly examined. We aim to analyze long-term results and the trend of left ventricular (LV) function after weaning from a durable VAD in our hospital. <h3>Methods</h3> Since September 2006, 344 durable VAD implantations were performed in the University of Tokyo Hospital, among which 30 patients were successfully weaned from the device. Twenty-five patients were enrolled in this study after excluding 5 patients who were treated for fulminant myocarditis. The majority of causative disease was idiopathic dilated cardiomyopathy in 24. They were implanted with paracorporeal (n = 12) or implantable (n = 13) VAD according to a reimbursement policy. Aggressive pharmacological treatment including titration of beta-blocker and ACE inhibitor or ARB along with aerobic rehabilitation was planned in all cases. Once a sign of functional recovery was recognized, our weaning protocol was initiated, such as cardiopulmonary exercise testing, VAD off-test and volume challenging test. Twenty-five patients met the weaning criteria, and underwent a VAD removal via redo median sternotomy. Long term survival was examined including repeated VAD implantation. Analysis of LV diastolic dimension and ejection fraction by echocardiography and BNP level was conducted to monitor LV function. <h3>Results</h3> Patients were weaned from the VAD after 333-day-long support without in-hospital death. All patients were followed-up for an average of 6 years. One-, 5-, and 10-year survival was 100%, 89.7% and 89.7%, and re-VAD-free survival was 91.8%, 85.7% and 85.7%, respectively. Notably, there was no death in patients who were weaned from implantable VAD. LVDd (67.7 mm) was significantly reduced before weaning (52.3 mm) and stabilized for a year. LVEF (19.5%) was significantly improved before weaning (43.4%) and further increased toward 1 year. BNP was significantly reduced before weaning and in the same level at 1year. <h3>Conclusion</h3> Long-term prognosis of patients who were weaned from durable VAD through our structured protocol was excellent. Bridge to recovery seems to aggressively be reappraised as a vital choice for durable VAD treatment.

Development of De-Novo Aortic Insufficiency in Patients with Durable Left Ventricular Assist Device Who Were Bridged from Impella Device

<h3>Purpose</h3> As the incidence of INTERMACS I profile patients receiving durable left ventricular assist devices(VADs) increases, there has been a rising use of Impella (Abiomed, Daners, MA) for acute support. While impella allows for end-organ recovery and safe bridging to VAD it has also been associated with the development of de-novo aortic insufficiency (AI) post VAD in small series. We evaluate the incidence and clinical significance of de-novo AI in post VAD patients at our center. <h3>Methods</h3> All patients implanted with durable VAD at our center from 2011-2021 were retrospectively reviewed. Echocardiogram were reviewed prior to VAD implant and 3 months post VAD for the development of de-novo AI. <h3>Results</h3> Forty-eight patients were implanted with Heartmate II or Heartmate 3 (Abbott, Chicago, IL) durable VAD. Twenty-seven patients were bridged with an Impella prior to VAD, while 21 were not. By definition, the Impella-bridged patients were INTERMACS 1 at time of VAD; 24 were male and the mean age was 65.3-years with 62.9% (N=17) with ischemic cardiomyopathy. In this group, 25.9% (N=7) of patients had at least moderate de-novo AI and 48% (N=13) had at least mild de-novo AI at 3 months post VAD. Three of the Impella bridged patients received aortic valve plication during VAD surgery due to significant AI, and at 3 months post VAD, all 3 patients had trace to no AI. Of the 21 patients not bridged with Impella, 17 were INTERMACS 2 and 4 were INTERMACS 3; 18 were male and the mean age was 62.7 years-old, with 61.9%(N=13) having ischemic cardiomyopathy. In this group, 19% (N=4) had at least moderate de-novo AI and 23.8% (N=5) had at least mild de-novo AI a 3 months post LVAD echocardiogram. One patient received prophylactic aortic valve plication during LVAD implantation due to significant baseline AI. No patients required aortic valve intervention post LVAD in the impella-bridged group, while 1 patient required TAVR for AI in the non-impella group. <h3>Conclusion</h3> This retrospective analysis of our single center experience shows that while there is an increased incidence of de-novo AI in VAD patients that are bridged with Impella, the presence of AI may not be clinically significant. By proper afterload reduction and diuresis as well as consideration of aortic plication in patients with at least moderate AI at time of VAD, morbidity of AI can be significantly minimized.

Impact of the 2016 Organ Procurement and Transplantation Network (OPTN) Pediatric Heart Allocation Policy Change on Use of Durable Ventricular Assist Devices and Heart Transplantation Rates in Children with Congenital Heart Disease versus Cardiomyopathy

<h3>Purpose</h3> In March 2016, the OPTN changed the pediatric heart allocation policy to prioritize congenital heart disease (CHD) patients on high inotropes for 1A listing to increase their heart transplantation (HT) rates than those with cardiomyopathy (CM). This study evaluates the use of durable ventricular assist devices (VADs) and HT in CHD versus CM patients before and after the policy change in the USA. <h3>Methods</h3> All patients ≤18-yrs-old listed for HT between December 2011 and November 2020 were included in the study. The cohort was stratified into those listed before (Era-1) and after (Era-2) the policy change. We analyzed demographics, listing status, ECMO, VADs use, waitlist duration and HT rates between CHD and CM patients. <h3>Results</h3> During the study period, 5,667 patients were listed for HT, with 3108 (55%) in Era-1 and 2559 (45%) in Era-2. Between Era-1 and Era-2, CHD patients were listed 1A in 67% vs 66% and 1B in 17% vs 12% whereas CM patients were listed 1A in 73% vs 49% and 1B in 8% vs 33% (p<0.01) (Table). In Era-2 compared to Era-1, ECMO use decreased in both CHD (5% vs 8%, p<0.01) and CM (6% vs 8%, p<0.01), conversely, durable VADs use increased significantly in both CHD (10% vs 5%, p<0.01) and CM (34% vs 25%, p <0.01) patients. Furthermore, the HT rate within 180 days of listing was unchanged in CHD (<b>53 % vs 51%, p=0.3</b>) and CM patients (<b>63% vs 64%, p=0.4</b>) in Era-2 compared to Era-1 (Figure). The waitlist duration for CHD patients increased from 73 to 83 days (p<0.01), but no significant change in CM patients (66 days). <h3>Conclusion</h3> The current allocation policy has positive impact on the use of VADs in both CHD and CM. However, there was no change in HT rates, no increase in listing as status 1A, and an increase in the waitlist duration among CHD patients. Future studies are needed to analyze the factors for the failure of the intended benefits of pediatric heart allocation policy changes.