title: Continuous Flow Device Support in Children Using the HeartWare HVAD: 1,000 Days of Lessons Learned From a Single Center Experience.
abstract: The purpose of this study is to provide a single center experience with a continuous flow device in adolescents with end-stage heart failure. A retrospective single center analysis of patients aged 18 years or younger implanted with HVAD (HeartWare Inc, Framingham, MA) between October 2012 and March 2014 was performed. Demographics, preimplant and postimplant clinical data, survival, and adverse events (AEs) were recorded. A matched group of adults based on diagnosis, body surface area (BSA), and time period were used for outcome comparisons. Six adolescents with dilated cardiomyopathy were implanted with the HVAD. Median age and BSA were 13.4 years and 1.45 m2, respectively. All were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile-1 or profile-2. Median days on device were 108 with total patient-days on device of 1,017. Four adolescents were discharged home on device all in New York Heart Association 1. Five underwent transplantation with 100% survival. There were 18 AEs with one AE per 170 days on device. Compared with the adult cohort (n = 5), there was no difference in 1 year survival (p = 0.32). HVAD support in adolescents is highly successful as a bridge to transplantation. It provides early rehabilitation and improvement in quality of life. Morbidity is not negligible but appears comparable with that seen in adults.
authors.affiliation: From the *Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, Louisville, Kentucky; †Division of Cardiothoracic Surgery, Department of Surgery, ‡Division of Pediatric Critical Care, Department of Pediatrics, Washington University School of Medicine St. Louis, Missouri; §Department of Critical Care, St. Louis Children's Hospital, St. Louis, Missouri; and ¶Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Joshua
authors.initials: J
authors.lastname: Sparks
authors.forename: Deirdre
authors.initials: D
authors.lastname: Epstein
authors.forename: Sirine
authors.initials: S
authors.lastname: Baltagi
authors.forename: Mary E
authors.initials: ME
authors.lastname: Mehegan
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Simpson
authors.forename: Charles E
authors.initials: CE
authors.lastname: Canter
authors.forename: Scott
authors.initials: S
authors.lastname: Silvestry
authors.forename: Pirooz
authors.initials: P
authors.lastname: Eghtesady
authors.forename: Umar S
authors.initials: US
authors.lastname: Boston
mesh_terms: D000293:Adolescent; D000328:Adult; D001775:Blood Circulation / Q000502:physiology; D009202:Cardiomyopathies / Q000601:surgery*; D002648:Child; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D012189:Retrospective Studies