Paediatric heart transplantation - the impact of a ventricular assist device on operative outcomes.
BACKGROUND
The use of a ventricular assist device (VAD) is a life-saving option for patients with heart failure refractory to conventional therapy.


OBJECTIVE
To assess the effect of VAD on outcomes of heart transplantation in children.


METHODS
Between October 1988 and June 2009, a consecutive series of 95 children (mean age 8.6 + or - 6.7 years, range 5 days-17.9 years) underwent heart transplantation: patients in group 1 (n = 11) received VAD as a bridge to cardiac transplantation (left ventricular VAD in 4, biventricular VAD in 7), and patients in group 2 (n = 84) underwent heart transplantation without previous cardiac support using VAD. The indication for heart transplantation was cardiomyopathy/myocarditis in 66 (69.5%) of children and congenital heart disease in 29 (30.5%) patients.


RESULTS
Congenital heart disease was diagnosed more often in group 2 than in group 1 (p = 0.047). The two groups did not differ significantly with respect to age, weight and parameters of preoperative liver and kidney function (except for aspartate aminotransferase activity, p = 0.020). The mean waiting time for transplantation was 64.2 + or - 87.4 days (range 1-443 days) and did not differ between the groups. The mean follow-up was 6.8 + or - 5.4 years (range 1 day-17.6 years). Mortality during long-term follow-up was 9.1% (n = 1) in group 1 and 20.2% (n=17) in group 2 (p = 0.632). We found no significant differences in postoperative ventilatory support time (p = 0.773), duration of hospital stay (p = 0.853), and incidence of acute rejection episodes (p = 0.575).


CONCLUSIONS
The use of VAD as a bridge to heart transplantation in children with severe heart failure had no negative effect on treatment outcomes.
Januszewska
Katarzyna
K
Department of Cardiac Surgery, Ludwig Maximilian University, Munchen, Germany. mijanusz@cyf-kr.edu.pl
Malec
Edward
E
Birnbaum
Julia
J
Loeff
Markus
M
Sodian
Ralf
R
Schmitz
Christoph
C
Netz
Heinrich
H
Reichart
Bruno
B
D000293:Adolescent; D009202:Cardiomyopathies / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009205:Myocarditis / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome