Centrifugal-flow ventricular assist device support in children: A single-center experience

Iki Adachi, Rodrigo Zea-Vera, Hari Tunuguntla, Susan W. Denfield, Barbara Elias, Rija John, Jun Teruya, Charles Fraser

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Our institutional policy is to continue centrifugal-flow ventricular assist device support for 3 months or more without activation on the transplant wait-list for physical recovery and assessment of possible myocardial recovery. We evaluated our single-institutional outcomes with centrifugal-flow ventricular assist device support in children. Methods: Prospectively collected outcomes data in consecutive patients aged 18 years or less with centrifugal-flow ventricular assist device support were reviewed. Results: There were 40 implantations in 39 patients (28 with cardiomyopathy, 11 with congenital heart disease, including 3 with univentricular physiology). The median support was 8 months (range, 1-79), with 13 patients (33%) supported for 12 months or more and a cumulative duration of 41 patient-years. The median age and weight at implantation were 11 (4-18) years and 35 (14-98) kg, respectively. The median body surface area was 1.1 (0.7-2.2) m 2 , with 16 patients (40%) having a body surface area less than 1.0 m 2 . Thirty-four patients (85%) had Interagency Registry for Mechanically Assisted Circulatory Support 1 or 2. Children with congenital heart disease were significantly smaller (P <.01) and had more prior cardiac interventions (P <.01) than those with cardiomyopathy. There were 2 early mortalities (5%) in children with cardiomyopathy. Of the 38 patients with successful implantations, 36 (95%) were discharged home and managed as outpatients. Overall adverse event rates were 5.1 (bleeding), 0.8 (device malfunction), 6.1 (infection), 3.9 (neurologic dysfunction), and 1.0 (renal dysfunction) (per 100 patient-month). In the 21 patients with cardiomyopathy supported for 3 months or more, 5 (24%) experienced normalization of left ventricular function; 4 underwent successful explantation, and 1 remains on support. Conclusions: This study demonstrates favorable outcomes of centrifugal-flow ventricular assist device support in children, including those with congenital heart disease, with an increased incidence of cardiac recovery.

Original languageEnglish (US)
Pages (from-to)1609-1617.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number4
DOIs
StatePublished - Apr 1 2019

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Heart-Assist Devices
Cardiomyopathies
Heart Diseases
Body Surface Area
Organizational Policy
Neurologic Manifestations
Left Ventricular Function
Registries
Outpatients
Hemorrhage
Transplants
Kidney
Weights and Measures
Equipment and Supplies
Mortality
Incidence

Keywords

  • heart failure
  • mechanical circulatory support
  • outcomes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Centrifugal-flow ventricular assist device support in children : A single-center experience. / Adachi, Iki; Zea-Vera, Rodrigo; Tunuguntla, Hari; Denfield, Susan W.; Elias, Barbara; John, Rija; Teruya, Jun; Fraser, Charles.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 4, 01.04.2019, p. 1609-1617.e2.

Research output: Contribution to journalArticle

Adachi, I, Zea-Vera, R, Tunuguntla, H, Denfield, SW, Elias, B, John, R, Teruya, J & Fraser, C 2019, 'Centrifugal-flow ventricular assist device support in children: A single-center experience', Journal of Thoracic and Cardiovascular Surgery, vol. 157, no. 4, pp. 1609-1617.e2. https://doi.org/10.1016/j.jtcvs.2018.12.045
Adachi, Iki ; Zea-Vera, Rodrigo ; Tunuguntla, Hari ; Denfield, Susan W. ; Elias, Barbara ; John, Rija ; Teruya, Jun ; Fraser, Charles. / Centrifugal-flow ventricular assist device support in children : A single-center experience. In: Journal of Thoracic and Cardiovascular Surgery. 2019 ; Vol. 157, No. 4. pp. 1609-1617.e2.
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abstract = "Background: Our institutional policy is to continue centrifugal-flow ventricular assist device support for 3 months or more without activation on the transplant wait-list for physical recovery and assessment of possible myocardial recovery. We evaluated our single-institutional outcomes with centrifugal-flow ventricular assist device support in children. Methods: Prospectively collected outcomes data in consecutive patients aged 18 years or less with centrifugal-flow ventricular assist device support were reviewed. Results: There were 40 implantations in 39 patients (28 with cardiomyopathy, 11 with congenital heart disease, including 3 with univentricular physiology). The median support was 8 months (range, 1-79), with 13 patients (33{\%}) supported for 12 months or more and a cumulative duration of 41 patient-years. The median age and weight at implantation were 11 (4-18) years and 35 (14-98) kg, respectively. The median body surface area was 1.1 (0.7-2.2) m 2 , with 16 patients (40{\%}) having a body surface area less than 1.0 m 2 . Thirty-four patients (85{\%}) had Interagency Registry for Mechanically Assisted Circulatory Support 1 or 2. Children with congenital heart disease were significantly smaller (P <.01) and had more prior cardiac interventions (P <.01) than those with cardiomyopathy. There were 2 early mortalities (5{\%}) in children with cardiomyopathy. Of the 38 patients with successful implantations, 36 (95{\%}) were discharged home and managed as outpatients. Overall adverse event rates were 5.1 (bleeding), 0.8 (device malfunction), 6.1 (infection), 3.9 (neurologic dysfunction), and 1.0 (renal dysfunction) (per 100 patient-month). In the 21 patients with cardiomyopathy supported for 3 months or more, 5 (24{\%}) experienced normalization of left ventricular function; 4 underwent successful explantation, and 1 remains on support. Conclusions: This study demonstrates favorable outcomes of centrifugal-flow ventricular assist device support in children, including those with congenital heart disease, with an increased incidence of cardiac recovery.",
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AU - Denfield, Susan W.

AU - Elias, Barbara

AU - John, Rija

AU - Teruya, Jun

AU - Fraser, Charles

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