Outcomes of Children Supported With Pulsatile Paracorporeal Ventricular Assist Device: Congenital Versus Acquired Heart Disease

Abstract

Background We reviewed the outcomes of 82 consecutive pediatric patients (less than 18 years of age) supported with the Berlin Heart ventricular assist device (VAD), comparing those with congenital heart disease (CHD; n  =  44) with those with acquired heart disease (AHD; n  =  37). Methods The primary outcome was mortality after VAD insertion. Kaplan-Meier methods and log-rank tests were used to assess group differences in long-term survival. Results Forty-four CHD patients were supported (age: median  =  65 days, range  =  4 days-13.3 years; weight [kg]: median  =  4, range  =  2.4-42.3). Ten biventricular CHD patients were supported with eight biventricular assist devices (BiVADs), one left ventricular assist device (LVAD) only, and one LVAD converted to BiVAD, while 34 univentricular CHD patients were supported with single ventricle-ventricular assist devices (sVADs). In CHD patients, duration of VAD support was [days]: median  =  134, range  =  4-554. Of 44 CHD patients, 28 underwent heart transplantation, 15 died on VAD, and one was still on VAD. Thirty-seven AHD patients were supported (age: median  =  1.9 years, range  =  27 days-17.7 years; weight [kg]: median  =  11, range  =  3.1-112), including 34 BiVAD and 3 LVAD. In AHD patients, duration of VAD support was [days]: median  =  97, range  =  4-315. Of 37 AHD patients, 28 underwent transplantation, three died on VAD, five weaned off VAD (one of whom underwent heart transplantation 334 days after weaning), and one was still on VAD. One-year survival after VAD insertion was 59.9% (95% CI  =  46.7%-76.7%) in CHD and 88.6% (95% CI  =  78.8%-99.8%) in AHD, P  =  .0004. Five-year survival after VAD insertion was 55.4% (95% CI  =  40.8%-75.2%) in CHD and 85.3% (95% CI  =  74.0%-98.2%) in AHD, P  =  .002. Conclusions Pulsatile VAD facilitates bridge-to-transplantation in neonates, infants, and children with CHD; however, survival after VAD insertion is worse in patients with CHD than in patients with AHD.