Modern Outcomes of Mechanical Circulatory Support as a Bridge to Pediatric Heart Transplantation

Brody Wehman, Kristen A. Stafford, Gregory J. Bittle, Zachary N. Kon, Charles Evans, Keshava Rajagopal, Nicholas Pietris, Sunjay Kaushal, Bartley P. Griffith

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background Pediatric patients awaiting orthotopic heart transplantation frequently require bridge to transplantation (BTT) with mechanical circulatory support. Posttransplant survival outcomes and predictors of mortality have not been thoroughly described in the modern era using a large-scale analysis. Methods The United Network for Organ Sharing database was reviewed to identify pediatric heart transplant recipients from 2005 through 2012. Patients were stratified into three groups: extracorporeal membrane oxygenation (ECMO), ventricular assist device (VAD), and direct transplantation (DTXP). The primary outcome was posttransplant survival. Results Two thousand seven hundred seventy-seven pediatric patients underwent orthotopic heart transplantation. There were 617 patients who required BTT with mechanical circulatory support (22.2%), of whom there were 428 VAD BTT (69.4%) and 189 ECMO BTT (30.6%). An increase in VAD use was observed during the study period (p < 0.0001). Compared with DTXP, patients in the ECMO BTT group had a lower median age (<1 versus 5 years; p < 0.0001) and were significantly smaller (8 versus 14 kg; p < 0.001), whereas patients in the VAD BTT group were older (8 versus 5 years; p = 0.0002) and larger (24 versus 14 kg; p < 0.001). Actuarial survival was greater in the DTXP group compared with ECMO BTT, but similar to VAD BTT at 30 days and 1, 3, and 5 years. However, this survival difference was lost after censoring the first 4 months after transplant. In multivariable analysis, when restricted to the first 4 months of survival, independent predictors for mortality were ECMO BTT, age, diagnosis, and functional status, whereas VAD BTT was not. Conclusions Pediatric patients with DTXP or VAD BTT have equivalent posttransplant survival. However, those requiring ECMO BTT have inferior early posttransplant survival compared with those receiving DTXP.

Original languageEnglish (US)
Pages (from-to)2321-2327
Number of pages7
JournalAnnals of Thoracic Surgery
Volume101
Issue number6
DOIs
StatePublished - Jun 1 2016

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Heart Transplantation
Transplantation
Pediatrics
Heart-Assist Devices
Extracorporeal Membrane Oxygenation
Survival
Mortality
Databases

All Science Journal Classification (ASJC) codes

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

Cite this

Wehman, B., Stafford, K. A., Bittle, G. J., Kon, Z. N., Evans, C., Rajagopal, K., ... Griffith, B. P. (2016). Modern Outcomes of Mechanical Circulatory Support as a Bridge to Pediatric Heart Transplantation. Annals of Thoracic Surgery, 101(6), 2321-2327. https://doi.org/10.1016/j.athoracsur.2015.12.003
Wehman, Brody ; Stafford, Kristen A. ; Bittle, Gregory J. ; Kon, Zachary N. ; Evans, Charles ; Rajagopal, Keshava ; Pietris, Nicholas ; Kaushal, Sunjay ; Griffith, Bartley P. / Modern Outcomes of Mechanical Circulatory Support as a Bridge to Pediatric Heart Transplantation. In: Annals of Thoracic Surgery. 2016 ; Vol. 101, No. 6. pp. 2321-2327.
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abstract = "Background Pediatric patients awaiting orthotopic heart transplantation frequently require bridge to transplantation (BTT) with mechanical circulatory support. Posttransplant survival outcomes and predictors of mortality have not been thoroughly described in the modern era using a large-scale analysis. Methods The United Network for Organ Sharing database was reviewed to identify pediatric heart transplant recipients from 2005 through 2012. Patients were stratified into three groups: extracorporeal membrane oxygenation (ECMO), ventricular assist device (VAD), and direct transplantation (DTXP). The primary outcome was posttransplant survival. Results Two thousand seven hundred seventy-seven pediatric patients underwent orthotopic heart transplantation. There were 617 patients who required BTT with mechanical circulatory support (22.2{\%}), of whom there were 428 VAD BTT (69.4{\%}) and 189 ECMO BTT (30.6{\%}). An increase in VAD use was observed during the study period (p < 0.0001). Compared with DTXP, patients in the ECMO BTT group had a lower median age (<1 versus 5 years; p < 0.0001) and were significantly smaller (8 versus 14 kg; p < 0.001), whereas patients in the VAD BTT group were older (8 versus 5 years; p = 0.0002) and larger (24 versus 14 kg; p < 0.001). Actuarial survival was greater in the DTXP group compared with ECMO BTT, but similar to VAD BTT at 30 days and 1, 3, and 5 years. However, this survival difference was lost after censoring the first 4 months after transplant. In multivariable analysis, when restricted to the first 4 months of survival, independent predictors for mortality were ECMO BTT, age, diagnosis, and functional status, whereas VAD BTT was not. Conclusions Pediatric patients with DTXP or VAD BTT have equivalent posttransplant survival. However, those requiring ECMO BTT have inferior early posttransplant survival compared with those receiving DTXP.",
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Wehman, B, Stafford, KA, Bittle, GJ, Kon, ZN, Evans, C, Rajagopal, K, Pietris, N, Kaushal, S & Griffith, BP 2016, 'Modern Outcomes of Mechanical Circulatory Support as a Bridge to Pediatric Heart Transplantation', Annals of Thoracic Surgery, vol. 101, no. 6, pp. 2321-2327. https://doi.org/10.1016/j.athoracsur.2015.12.003

Modern Outcomes of Mechanical Circulatory Support as a Bridge to Pediatric Heart Transplantation. / Wehman, Brody; Stafford, Kristen A.; Bittle, Gregory J.; Kon, Zachary N.; Evans, Charles; Rajagopal, Keshava; Pietris, Nicholas; Kaushal, Sunjay; Griffith, Bartley P.

In: Annals of Thoracic Surgery, Vol. 101, No. 6, 01.06.2016, p. 2321-2327.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Modern Outcomes of Mechanical Circulatory Support as a Bridge to Pediatric Heart Transplantation

AU - Wehman, Brody

AU - Stafford, Kristen A.

AU - Bittle, Gregory J.

AU - Kon, Zachary N.

AU - Evans, Charles

AU - Rajagopal, Keshava

AU - Pietris, Nicholas

AU - Kaushal, Sunjay

AU - Griffith, Bartley P.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background Pediatric patients awaiting orthotopic heart transplantation frequently require bridge to transplantation (BTT) with mechanical circulatory support. Posttransplant survival outcomes and predictors of mortality have not been thoroughly described in the modern era using a large-scale analysis. Methods The United Network for Organ Sharing database was reviewed to identify pediatric heart transplant recipients from 2005 through 2012. Patients were stratified into three groups: extracorporeal membrane oxygenation (ECMO), ventricular assist device (VAD), and direct transplantation (DTXP). The primary outcome was posttransplant survival. Results Two thousand seven hundred seventy-seven pediatric patients underwent orthotopic heart transplantation. There were 617 patients who required BTT with mechanical circulatory support (22.2%), of whom there were 428 VAD BTT (69.4%) and 189 ECMO BTT (30.6%). An increase in VAD use was observed during the study period (p < 0.0001). Compared with DTXP, patients in the ECMO BTT group had a lower median age (<1 versus 5 years; p < 0.0001) and were significantly smaller (8 versus 14 kg; p < 0.001), whereas patients in the VAD BTT group were older (8 versus 5 years; p = 0.0002) and larger (24 versus 14 kg; p < 0.001). Actuarial survival was greater in the DTXP group compared with ECMO BTT, but similar to VAD BTT at 30 days and 1, 3, and 5 years. However, this survival difference was lost after censoring the first 4 months after transplant. In multivariable analysis, when restricted to the first 4 months of survival, independent predictors for mortality were ECMO BTT, age, diagnosis, and functional status, whereas VAD BTT was not. Conclusions Pediatric patients with DTXP or VAD BTT have equivalent posttransplant survival. However, those requiring ECMO BTT have inferior early posttransplant survival compared with those receiving DTXP.

AB - Background Pediatric patients awaiting orthotopic heart transplantation frequently require bridge to transplantation (BTT) with mechanical circulatory support. Posttransplant survival outcomes and predictors of mortality have not been thoroughly described in the modern era using a large-scale analysis. Methods The United Network for Organ Sharing database was reviewed to identify pediatric heart transplant recipients from 2005 through 2012. Patients were stratified into three groups: extracorporeal membrane oxygenation (ECMO), ventricular assist device (VAD), and direct transplantation (DTXP). The primary outcome was posttransplant survival. Results Two thousand seven hundred seventy-seven pediatric patients underwent orthotopic heart transplantation. There were 617 patients who required BTT with mechanical circulatory support (22.2%), of whom there were 428 VAD BTT (69.4%) and 189 ECMO BTT (30.6%). An increase in VAD use was observed during the study period (p < 0.0001). Compared with DTXP, patients in the ECMO BTT group had a lower median age (<1 versus 5 years; p < 0.0001) and were significantly smaller (8 versus 14 kg; p < 0.001), whereas patients in the VAD BTT group were older (8 versus 5 years; p = 0.0002) and larger (24 versus 14 kg; p < 0.001). Actuarial survival was greater in the DTXP group compared with ECMO BTT, but similar to VAD BTT at 30 days and 1, 3, and 5 years. However, this survival difference was lost after censoring the first 4 months after transplant. In multivariable analysis, when restricted to the first 4 months of survival, independent predictors for mortality were ECMO BTT, age, diagnosis, and functional status, whereas VAD BTT was not. Conclusions Pediatric patients with DTXP or VAD BTT have equivalent posttransplant survival. However, those requiring ECMO BTT have inferior early posttransplant survival compared with those receiving DTXP.

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