title: Ventricular assist devices in a contemporary pediatric cohort: Morbidity, functional recovery, and survival.
abstract: BACKGROUND
  Limited availability of donor organs has led to the use of ventricular assist devices (VADs) to treat heart failure in pediatric patients, primarily as bridge to transplantation. How effective VAD therapy is in promoting functional recovery in children is currently not known.
  
  
  METHODS
  We report morbidity and mortality as defined by the Interagency Registry for Mechanically Assisted Circulatory Support Modified for Pediatrics (PediMACS) and the use of the Treatment Intensity Score to assess functional status for 50 VAD patients supported at a single pediatric program from 2004 to 2013.
  
  
  RESULTS
  In this cohort, 30-day survival on VAD was 98%, and 180-day survival was 83%. Stroke occurred in 11 patients (22%), with 8 (16%) resulting in persistent neurologic deficit or death. The adverse event rate was 2-fold to 3-fold higher in the first 7 days of support compared with the subsequent support period. Functional status, as measured by the Treatment Intensity Score, improved with duration of support. Successful bridge to transplantation was associated with fewer adverse events during support and greater improvement in the Treatment Intensity Score during the period of support.
  
  
  CONCLUSIONS
  Overall survival in this cohort is excellent. The risk of serious adverse events decreases over the first month of support. However, a clinically significant risk of morbidity and mortality persists for the duration of pediatric VAD support. Measures of functional status improve with duration of support and are associated with survival to transplantation.
authors.affiliation: Pediatrics and Anesthesiology, Stanford Hospitals and Clinics.
authors.forename: Mary Lynette
authors.initials: ML
authors.lastname: Stein
authors.affiliation: Stanford University School of Medicine.
authors.forename: Duy T
authors.initials: DT
authors.lastname: Dao
authors.affiliation: Stanford University School of Medicine.
authors.forename: Lan N
authors.initials: LN
authors.lastname: Doan
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Palo Alto, California.
authors.forename: Olaf
authors.initials: O
authors.lastname: Reinhartz
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Palo Alto, California.
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford University, Palo Alto, California.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Hollander
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of California-San Diego School of Medicine, San Diego, California.
authors.forename: Justin
authors.initials: J
authors.lastname: Yeh
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford University, Palo Alto, California.
authors.forename: Beth D
authors.initials: BD
authors.lastname: Kaufman
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford University, Palo Alto, California.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Almond
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford University, Palo Alto, California. Electronic address: davidnr@stanford.edu.
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications* / Q000628:therapy; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity / Q000639:trends; D020127:Recovery of Function / Q000502:physiology*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016276:Ventricular Function / Q000502:physiology*
keywords: PediMACS; Treatment Intensity Score; bridge to transplant; pediatric heart transplant; survival; ventricular assist device