title: The impact of mechanical circulatory support on outcomes in paediatric heart transplantation.
abstract: OBJECTIVE
  Internationally, the number of donors for cardiac transplantation has remained static, while the number of patients requiring transplantation for congenital heart disease (CHD) has increased. Although the availability of mechanical circulatory support (MCS) may increase the number of transplants performed by reducing deaths while waiting, it may also lead to increased morbidity post-transplantation. We sought to assess the impact of mechanical support on post-transplant outcomes in a single centre.
  
  
  METHODS
  We assessed the outcomes of paediatric (age ≤16 years) heart transplantation in a single unit in the era of mechanical support (1998-2012) by retrospective cohort study. Outcomes before (1998-2005) and after (2005-2012) the routine use of the Berlin Heart EXCOR device were contrasted.
  
  
  RESULTS
  A total of 167 patients underwent heart transplantation during this period. The diagnosis was dilated cardiomyopathy in 61.7%, two-ventricle CHD in 11.4%, single ventricle CHD in 16.8% and miscellaneous in 10.1%. Sixty-nine (41%) were bridged to transplant by mechanical support; with extracorporeal membrane oxygenation in 19 (28%), ventricular assist device in 40 (58%) and a combination in 10 (14.0%). Post-transplant mortality at 30 days was significantly greater in those supported by MCS than without (7 vs 1%, P < 0.05), and a greater proportion of patients had neurological (23 vs 8%, P < 0.01) and major respiratory sequelae (20 vs 4%, P < 0.001). There was no significant increase in the need for post-transplant mechanical support (10 vs 6%, P = 0.3) in those supported prior to transplant. The number of transplants performed increased from 67 in 1998-2005 to 100 in the most recent era (2005-2012), and an increased proportion of these patients have been supported mechanically prior to transplantation (51 vs 27%, P < 0.01).
  
  
  CONCLUSIONS
  Along with strategies to increase donor utilization, MCS has allowed an increase in cardiac transplant activity at the expense of a higher early mortality and morbidity.
authors: Department of Paediatric Cardiac Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors: Phil
authors: P
authors: Botha
authors: Ruth
authors: R
authors: Solana
authors: Jane
authors: J
authors: Cassidy
authors: Gareth
authors: G
authors: Parry
authors: Richard
authors: R
authors: Kirk
authors: Asif
authors: A
authors: Hasan
authors: Massimo
authors: M
authors: Griselli
mesh_terms: D000293:Adolescent; D001243:Assisted Circulation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Congestive heart failure; Mechanical circulatory assistance; Transplantation—heart