The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: an analysis of the United Network for Organ Sharing database.
OBJECTIVE
The use of mechanical circulatory support to bridge pediatric patients to cardiac transplantation presents unique challenges because of the difficult anatomy and physiology in these patients.


METHODS
The United Network for Organ Sharing provided deidentifed patient-level data. The study population included 2532 transplantations performed on patients less than 19 years old in status 1/1A/1B between 1995 and 2005. Mechanical circulatory support was used in 431 patients: 241 (9.5%) received ventricular assist devices, 171 (6.8%) underwent extracorporeal membrane oxygenation, and 19 (0.8%) received intra-aortic balloon pumps.


RESULTS
Patients supported on ventricular assist devices had similar levels of hospitalization and intensive care use and less need for inotropic support (P < .0002) than had those not needing support. Five- and 10-year posttransplantation survival was better in patients receiving ventricular assist devices and patients not receiving mechanical circulatory support than in patients receiving extracorporeal membrane oxygenation or intra-aortic balloon pumping (P < .0001). Among mechanically supported patients, patients with a body surface area of less than 0.30 (odds ratio, 1.70; 95% confidence interval, 1.18-2.43) and those requiring extracorporeal membrane oxygenation (odds ratio, 1.65; 95% confidence interval, 1.15-2.35) or intra-aortic balloon pumping (odds ratio, 1.91; 95% confidence interval, 1.02-3.56) had higher long-term mortality. The use of a ventricular assist device at transplantation did not predict higher long-term, posttransplantation mortality.


CONCLUSIONS
Pediatric patients requiring a pretransplantation ventricular assist device have long-term survival similar to that of patients not receiving mechanical circulatory support. Early survival among patients undergoing extracorporeal membrane oxygenation and infants is poor, reinforcing the need for improvements in device design and physiologic management of infants and neonates.
Davies
Ryan R
RR
Division of Cardiothoracic Surgery, Children's Hospital of New York-Presbyterian and Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Russo
Mark J
MJ
Hong
Kimberly N
KN
O'Byrne
Michael L
ML
Cork
David P
DP
Moskowitz
Alan J
AJ
Gelijns
Annetine C
AC
Mital
Seema
S
Mosca
Ralph S
RS
Chen
Jonathan M
JM
D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D008297:Male; D016017:Odds Ratio; D018579:Patient Selection; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014850:Waiting Lists