Single Ventricular Assist Device Care and Outcomes for Failed Stage I Palliation: A Single-Center Decade of Experience.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
09 Feb 2024
09 Feb 2024
Historique:
medline:
12
2
2024
pubmed:
12
2
2024
entrez:
12
2
2024
Statut:
aheadofprint
Résumé
Single ventricular assist device (SVAD) use before and after stage I palliation (S1P) is increasing with limited data on outcomes. To address this knowledge gap, we conducted a single-center retrospective review to assess pre- and post-SVAD clinical status, complications, and outcomes. We leveraged a granular, longitudinal, local database that captures end-organ support, procedural interventions, hematologic events, laboratory data, and antithrombotic strategy. We identified 25 patients between 2013 and 2023 implanted at median age of 53 days (interquartile range [IQR] = 16-130); 80% had systemic right ventricles and underwent S1P. Median SVAD days were 54 (IQR = 29-86), and 40% were implanted directly from ECMO. Compared to preimplant, there was a significant reduction in inotrope use (p = 0.013) and improved weight gain (p = 0.008) post-SVAD. Complications were frequent including bleeding (80%), stroke (40%), acute kidney injury (AKI) (40%), infection (36%), and unanticipated catheterization (56%). Patients with in-hospital mortality had significantly more bleeding complications (p = 0.02) and were more likely to have had Blalock-Thomas-Taussig shunts pre-SVAD (p = 0.028). Survival to 1 year postexplant was 40% and included three recovered and explanted patients. At 1 year posttransplant, all survivors have technology dependence or neurologic injury. This study highlights the clinical outcomes and ongoing support required for successful SVAD use in failed single-ventricle physiology before or after S1P.
Identifiants
pubmed: 38346282
doi: 10.1097/MAT.0000000000002149
pii: 00002480-990000000-00413
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © ASAIO 2024.
Références
Joong A, Maeda K, Peng DM, Investigators BALN: Ventricular assist device outcomes in infants and children with stage 1 single ventricle palliation. ASAIO J 68: e188–e195, 2022.
Peng DM, Koehl DA, Cantor RS, et al.: Outcomes of children with congenital heart disease implanted with ventricular assist devices: An analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs). J Heart Lung Transplant 38: 420–430, 2019.
Conway J, St Louis J, Morales DLS, Law S, Tjossem C, Humpl T: Delineating survival outcomes in children <10 kg bridged to transplant or recovery with the Berlin Heart EXCOR Ventricular Assist Device. JACC Heart Fail 3: 70–77, 2015.
Mahle WT, Hu C, Trachtenberg F, et al.; Pediatric Heart Network Investigators: Heart failure after the Norwood procedure: An analysis of the single ventricle reconstruction trial. J Heart Lung Transplant 37: 879–885, 2018.
Weinstein S, Bello R, Pizarro C, et al.: The use of the Berlin Heart EXCOR in patients with functional single ventricle. J Thorac Cardiovasc Surg 147: 697–704; discussion 704–705, 2014.
Friedland-Little JM, Joong A, Shugh SB, et al.: Patient and device selection in pediatric MCS: A review of current consensus and unsettled questions. Pediatr Cardiol 43: 1193–1204, 2022.
Gazit AZ, Petrucci O, Manning P, et al.: A novel surgical approach to mechanical circulatory support in univentricular infants. Ann Thorac Surg 104: 1630–1636, 2017.
Joong A, Gossett JG, Blume ED, et al.: Variability in clinical decision-making for ventricular assist device implantation in pediatrics. Pediatr Transplant 24: e13840, 2020.
Merritt T, Gazit AZ, Carvajal H, et al.: Evolution of ventricular assist device support strategy in children with univentricular physiology. Ann Thorac Surg 114: 1739–1744, 2022.
Chen S, Rosenthal DN, Murray J, et al.: Bridge to transplant with ventricular assist device support in pediatric patients with single ventricle heart disease. ASAIO J 66: 205–211, 2020.
Selewski DT, Charlton JR, Jetton JG, et al.: Neonatal acute kidney injury. Pediatrics 136: e463–e473, 2015.
Neu J: Necrotizing enterocolitis: The search for a unifying pathogenic theory leading to prevention. Pediatr Clin North Am 43: 409–432, 1996.
McDiarmid SV, Anand R, Lindblad AS; Principal Investigators and Institutions of the Studies of Pediatric Liver Transplantation (SPLIT) Research Group: Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation 74: 173–181, 2002.
Philip J, Powers E, Machado D, et al.: Pulsatile ventricular assist device as a bridge to transplant for the early high-risk single-ventricle physiology. J Thorac Cardiovasc Surg 162: 405–413.e4, 2021.
Carlo WF, Villa CR, Lal AK, Morales DL: Ventricular assist device use in single ventricle congenital heart disease [Epub September 15, 2017]. Pediatr Transplant 21: 2017. doi: 10.1111/petr.13031.
doi: 10.1111/petr.13031
Lal AK, Chen S, Maeda K, et al.: Successful bridge to transplant with a continuous flow ventricular assist device in a single ventricle patient with an aortopulmonary shunt. ASAIO J 60: 119–121, 2014.
Pearce FB, Kirklin JK, Holman WL, Barrett CS, Romp RL, Lau YR: Successful cardiac transplant after Berlin Heart bridge in a single ventricle heart: Use of aortopulmonary shunt as a supplementary source of pulmonary blood flow. J Thorac Cardiovasc Surg 137: e40–e42, 2009.
Adachi I: Ventricular assist device implantation for single ventricle. Oper Tech Thorac Cardiovasc Surg 25: 74–84, 2020.
Schmidt T, Rosenthal D, Reinhartz O, et al.; Modeling of Congenital Hearts Alliance (MOCHA)+ Investigators: Superior performance of continuous over pulsatile flow ventricular assist devices in the single ventricle circulation: A computational study. J Biomech 52: 48–54, 2017.
Villa CR, VanderPluym CJ; ACTION Investigators: ABCs of stroke prevention: Improving stroke outcomes in children supported with a ventricular assist device in a quality improvement network. Circ Cardiovasc Qual Outcomes 13: e006663, 2020.
Ohye RG, Sleeper LA, Mahony L, et al.; Pediatric Heart Network Investigators: Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 362: 1980–1992, 2010.
Bleiweis MS, Philip J, Peek GJ, et al.: Palliation plus ventricular assist device insertion in 15 neonates and infants with functionally univentricular circulation. Ann Thorac Surg 114: 1412–1418, 2022.
Rosenthal DN, Almond CS, Jaquiss RD, et al.: Adverse events in children implanted with ventricular assist devices in the United States: Data from the pediatric interagency registry for mechanical circulatory support (PediMACS). J Heart Lung Transplant 35: 569–577, 2016.
Rossano JW, VanderPluym CJ, Peng DM, et al.; Pedimacs Investigators: Fifth annual pediatric interagency registry for mechanical circulatory support (Pedimacs) report. Ann Thorac Surg 112: 1763–1774, 2021.
Giglia TM, Massicotte MP, Tweddell JS, et al.; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Stroke Council: Prevention and treatment of thrombosis in pediatric and congenital heart disease: A scientific statement from the American Heart Association. Circulation 128: 2622–2703, 2013.
Gupta N, Zhao YY, Evans CE: The stimulation of thrombosis by hypoxia. Thromb Res 181: 77–83, 2019.
Pilli VS, Datta A, Afreen S, Catalano D, Szabo G, Majumder R: Hypoxia downregulates protein S expression. Blood 132: 452–455, 2018.
Silvey M, Brandão LR: Risk factors, prophylaxis, and treatment of venous thromboembolism in congenital heart disease patients. Front Pediatr 5: 146, 2017.
Zabala LM, Guzzetta NA: Cyanotic congenital heart disease (CCHD): Focus on hypoxemia, secondary erythrocytosis, and coagulation alterations. Paediatr Anaesth 25: 981–989, 2015.
Lorts A, Smyth L, Gajarski RJ, et al.: The creation of a pediatric health care learning network: The ACTION quality improvement collaborative. ASAIO J 66: 441–446, 2020.
Deshpande SJ, Vitali S, Thiagarajan R, Brediger S, McManus M, Geva A: Coagulations studies do not correlate with each other or with hematologic complications during pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med 22: 542–552, 2021.
Rabinowitz EJ, Ouyang A, Armstrong DR, Wallendorf M, Said AS: Poor reliability of common measures of anticoagulation in pediatric extracorporeal membrane oxygenation [Epub September 24, 2022]. ASAIO J 68: 850–858, 2022. doi: 10.1097/MAT.0000000000001582.
doi: 10.1097/MAT.0000000000001582