title: Evolution and impact of ventricular assist device program on children awaiting heart transplantation.
abstract: BACKGROUND
  We sought to evaluate the impact of the evolution of a pediatric mechanical circulatory support (MCS) program on outcomes of children listed for heart transplantation at our institution.
  
  
  METHODS
  All patients listed for isolated heart transplantation from 1995 to 2013 were included. The use of MCS while on the wait-list was recorded. Wait-list and posttransplant outcomes were compared before and after 2005, which was when we became capable of providing long-term MCS without size limitation.
  
  
  RESULTS
  In total, 259 patients were listed for transplant and 201 (78%) reached transplant. The use of MCS was significantly increased between the eras (13% and 37%, p = 0.0001). Wait-list mortality was significantly decreased (25% and 11%, p = 0.0006). Among transplant recipients, the proportion of patients who underwent MCS was significantly increased (13% and 37%, p = 0.0002). Of these MCS patients, the use of long-term devices was significantly increased (50% and 98%, p = 0.0004). Median duration of MCS was significantly increased (12 and 78 days, p = 0.004). Kaplan-Meier estimates showed a trend (p = 0.08) toward improved survival after bridge-to-transplant both at 1 year (70% in the early era and 88% in the late era) and at 5 years (60% and 78%, respectively).
  
  
  CONCLUSIONS
  Outcomes of pediatric heart transplantation have significantly improved over the last 2 decades. We believe such improvement is, at least in part, attributable to maturation of MCS strategy, characterized by avoiding the use of temporary devices such as extracorporeal membrane oxygenation as a bridge-to-transplant and a more aggressive use of long-term devices.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas. Electronic address: iadachi@bcm.edu.
authors.forename: Iki
authors.initials: I
authors.lastname: Adachi
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Guzmán-Pruneda
authors.affiliation: University of Texas at Houston School of Medicine, Houston, Texas.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Mery
authors.affiliation: Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Denfield
authors.affiliation: Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: William J
authors.initials: WJ
authors.lastname: Dreyer
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: David L S
authors.initials: DL
authors.lastname: Morales
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.
authors.forename: E Dean
authors.initials: ED
authors.lastname: McKenzie
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heinle
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult