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338 Outcomes of Pediatric Patients Supported by the Heartmate II LVAD in the USA
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The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012 initial post transplant mortality is higher. Survival after 3 months post transplant is identical between the medical and MCS groups. Whilst this is a resource intensive therapy overall 88% 1 year survival in the MCS group shows that good outcomes can be acheived. 338 Outcomes of Pediatric Patients Supported by the Heartmate II LVAD in the USA A.G. Cabrera,1 K. Sundareswaran,2 A.X. Samayoa,3 D.J. Farrar,2 O.H. Frazier,4 D.L.S. Morales.3 1Pediatrics, Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX; 2 Thoratec Corporation, Pleasanton, CA; 3Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX; 4 Texas Heart Institute, St. Luke’s Episcopal Hospital, Houston, TX.
Conclusions: Despite a known high rate of CVA, this initial report describes encouraging cognitive outcomes in children supported with VAD as bridge to transplant. 337 Mechanical Circulatory Support (MCS) as a Bridge to Paediatric Heart Transplant: Does the End Justify the Means? J.V. Cassidy, A. Wagh, S. Haynes, R. Kirk, L. Ferguson, J. Smith, M. Guillen, Y. Thiru, M. Griselli, A. Hasan. Paediatric Intensive Care Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom. Purpose: MCS as a bridge to cardiac transplant in children is common. We aimed to review the post transplant course of children on MCS as compared to medical support. Methods and Materials: Five year retrospective review (2005-10)of all first heart transplants. Results: 70 children received a first heart transplant. Commonest diagnosis was dilated cardiomyopathy (73%). 40 (57%) required MCS pre transplant. Commonest device used was the Berlin Heart (75%). The MCS group were younger (median age 2.8 years versus 8.3), more likely to be classed as NYHA IV and more likely to be in intensive care pre transplant. Survival was 83% in the MCS group vs 97% in the medical (p⫽0.07). Median length of hospital stay post transplant was 113 days in the MCS group vs 25 in the medical. 18% of the MCS group required long term ventilation post transplant as compared to none in the medical group (p⫽0.02). The stroke rate in the MCS group was 28% versus 7% in the medical (p⫽0.03). 71% of all post transplant positive blood cultures was in the MCS group.There was no increased risk of rejection and no difference in post transplant renal replacement therapy use.
Purpose: Heartmate II (HMII) continuous flow left ventricular assist device (LVAD) is an established treatment modality for advanced heart failure in adults. The objective of this study was to evaluate outcomes in patients supported with a HMII LVAD in the pediatric population. Methods and Materials: Retrospective review of the INTERMACS registry was conducted of patients supported with a HMII LVAD from April 2008-July 2011. Primary cohort comprised of pediatric patients (PED) who fell in the 0-18y age group. Outcomes were compared to an equivalent comparator group of young adults (YAD) between 19-39y implanted with a HMII during the same period. Ischemic etiology was excluded. Results: There were 26 pediatric patients; 18(69%) males, 12(46%) Blacks, and 10(38%) Whites. 7(27%) were implanted in a pediatric hospital. At 6mo follow-up, survival to transplantation, ongoing support, or recovery at 6mo was 95% for the PED group, which was not significantly different from the YAD group (96%, p⫽0.341). The two groups did not differ in INTERMACS profile but differed in diagnosis, weight and morbidities (Table 1). PED(n⫽26) Median weight (kg) (range) Primary Diagnosis Congenital heart disease Dilated Cardiomyopathy* Other INTERMACS profile 1 2 3 Competing outcome at 6mo Ongoing⬎6mo Ongoing⬍6mo Transplanted Explanted due to recovery Expired on Support Overall Success Adverse Events Bleeding requiring surgery* Stroke Driveline Infections Arrhythmias* Device malfunction*
76.1 (50–133)
YAD(n⫽319) 89.5 (29–178)
3 (11%) 21 (81%) 2 (8%)
7 (2%) 305 (96%) 7 (2%)
7 (27%) 12 (46%) 2 (8%)
63 (20%) 143 (45%) 70 (22%)
12 4 9 0 1 21/22
(46%) (15%) (35%) (0%) (4%) (95%)
3 2 5 9 5
(12%) (8%) (19%) (35%) (19%)
199 (63%) 43 (13%) 60 (19%) 5 (1%) 12 (4%) 264/276 (96%) 22 23 81 70 42
(7%) (7%) (25%) (22%) (13%)
*p-Value⬍0.05.
Conclusions: Outcomes in pediatric patients supported with a HMII are comparable to young adults, although there was a higher incidence of device malfunctions, arrhythmias, and bleeding requiring surgery. As we continue to follow this growing group of adolescents, more sophisticated characterization and comparisons will be possible. The mortality difference was manifest in the first 3 months post transplant with similar survival thereafter. Conclusions: The MCS group were significantly sicker preoperatively and
The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012 initial post transplant mortality is higher. Survival after 3 months post transplant is identical between the medical and MCS groups. Whilst this is a resource intensive therapy overall 88% 1 year survival in the MCS group shows that good outcomes can be acheived. 338 Outcomes of Pediatric Patients Supported by the Heartmate II LVAD in the USA A.G. Cabrera,1 K. Sundareswaran,2 A.X. Samayoa,3 D.J. Farrar,2 O.H. Frazier,4 D.L.S. Morales.3 1Pediatrics, Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX; 2 Thoratec Corporation, Pleasanton, CA; 3Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX; 4 Texas Heart Institute, St. Luke’s Episcopal Hospital, Houston, TX.
Conclusions: Despite a known high rate of CVA, this initial report describes encouraging cognitive outcomes in children supported with VAD as bridge to transplant. 337 Mechanical Circulatory Support (MCS) as a Bridge to Paediatric Heart Transplant: Does the End Justify the Means? J.V. Cassidy, A. Wagh, S. Haynes, R. Kirk, L. Ferguson, J. Smith, M. Guillen, Y. Thiru, M. Griselli, A. Hasan. Paediatric Intensive Care Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom. Purpose: MCS as a bridge to cardiac transplant in children is common. We aimed to review the post transplant course of children on MCS as compared to medical support. Methods and Materials: Five year retrospective review (2005-10)of all first heart transplants. Results: 70 children received a first heart transplant. Commonest diagnosis was dilated cardiomyopathy (73%). 40 (57%) required MCS pre transplant. Commonest device used was the Berlin Heart (75%). The MCS group were younger (median age 2.8 years versus 8.3), more likely to be classed as NYHA IV and more likely to be in intensive care pre transplant. Survival was 83% in the MCS group vs 97% in the medical (p⫽0.07). Median length of hospital stay post transplant was 113 days in the MCS group vs 25 in the medical. 18% of the MCS group required long term ventilation post transplant as compared to none in the medical group (p⫽0.02). The stroke rate in the MCS group was 28% versus 7% in the medical (p⫽0.03). 71% of all post transplant positive blood cultures was in the MCS group.There was no increased risk of rejection and no difference in post transplant renal replacement therapy use.
Purpose: Heartmate II (HMII) continuous flow left ventricular assist device (LVAD) is an established treatment modality for advanced heart failure in adults. The objective of this study was to evaluate outcomes in patients supported with a HMII LVAD in the pediatric population. Methods and Materials: Retrospective review of the INTERMACS registry was conducted of patients supported with a HMII LVAD from April 2008-July 2011. Primary cohort comprised of pediatric patients (PED) who fell in the 0-18y age group. Outcomes were compared to an equivalent comparator group of young adults (YAD) between 19-39y implanted with a HMII during the same period. Ischemic etiology was excluded. Results: There were 26 pediatric patients; 18(69%) males, 12(46%) Blacks, and 10(38%) Whites. 7(27%) were implanted in a pediatric hospital. At 6mo follow-up, survival to transplantation, ongoing support, or recovery at 6mo was 95% for the PED group, which was not significantly different from the YAD group (96%, p⫽0.341). The two groups did not differ in INTERMACS profile but differed in diagnosis, weight and morbidities (Table 1). PED(n⫽26) Median weight (kg) (range) Primary Diagnosis Congenital heart disease Dilated Cardiomyopathy* Other INTERMACS profile 1 2 3 Competing outcome at 6mo Ongoing⬎6mo Ongoing⬍6mo Transplanted Explanted due to recovery Expired on Support Overall Success Adverse Events Bleeding requiring surgery* Stroke Driveline Infections Arrhythmias* Device malfunction*
76.1 (50–133)
YAD(n⫽319) 89.5 (29–178)
3 (11%) 21 (81%) 2 (8%)
7 (2%) 305 (96%) 7 (2%)
7 (27%) 12 (46%) 2 (8%)
63 (20%) 143 (45%) 70 (22%)
12 4 9 0 1 21/22
(46%) (15%) (35%) (0%) (4%) (95%)
3 2 5 9 5
(12%) (8%) (19%) (35%) (19%)
199 (63%) 43 (13%) 60 (19%) 5 (1%) 12 (4%) 264/276 (96%) 22 23 81 70 42
(7%) (7%) (25%) (22%) (13%)
*p-Value⬍0.05.
Conclusions: Outcomes in pediatric patients supported with a HMII are comparable to young adults, although there was a higher incidence of device malfunctions, arrhythmias, and bleeding requiring surgery. As we continue to follow this growing group of adolescents, more sophisticated characterization and comparisons will be possible. The mortality difference was manifest in the first 3 months post transplant with similar survival thereafter. Conclusions: The MCS group were significantly sicker preoperatively and