title: Outcomes of ventricular assist device implantation in children and young adults: the Melbourne experience.
abstract: BACKGROUND
  We evaluated our experience with ventricular assist device (VAD) implantation in children and young adults.
  
  
  METHODS
  A total of 64 patients underwent VAD implantation in two centres. The mean age was 15 ± 7.2 years. Thirty-five (55%) patients were under 18 years of age. Devices implanted included the Thoratec Paracorporeal in 30 (47%) patients, Berlin Heart EXCOR in 11 (17%) and VentrAssist in 14 (22%). The diagnosis was cardiomyopathy in 53, congenital heart disease in 11, and graft failure in four patients.
  
  
  RESULTS
  There were 10 (16%) in-hospital deaths. Mortality was higher in patients <18 years of age (26% compared with 3.4% for those ≥18 years, P = 0.02). The use of extracorporeal membrane oxygenation prior to VAD implantation was associated with higher mortality (P = 0.006). Seventeen (27%) patients experienced stroke. Nine patients (14%) required change of VAD because of thrombosis. Transplantation was performed in 44 patients after a mean of 131 ± 141 days on VAD, 11 patients died without transplantation and three patients currently await transplantation. The VAD was explanted in six patients because of recovery. Overall survival from VAD implantation was 69% and 61% at 5 and 10 years, respectively. The 5-year post-transplant survival for those bridged with VAD support was 91% and was comparable with a cohort of patients who did not receive a pre-transplant VAD.
  
  
  CONCLUSIONS
  Children requiring pre-transplant VAD support have a higher mortality and morbidity compared with young adults. Survival after heart transplantation those supported with VADs was similar to patients of similar age who did not require pre-transplant support.
authors.affiliation: Departments of Cardiology and Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.|Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: William Y
authors.initials: WY
authors.lastname: Shi
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Silvana F
authors.initials: SF
authors.lastname: Marasco
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Saxena
authors.affiliation: Departments of Cardiology and Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.|Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
authors.affiliation: Departments of Cardiology and Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.|Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Yong
authors.affiliation: Departments of Cardiology and Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Sergei
authors.initials: S
authors.lastname: Mitnovetski
authors.affiliation: Departments of Cardiology and Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.|Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: McGiffin
authors.affiliation: Departments of Cardiology and Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.|Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Weintraub
authors.affiliation: Departments of Cardiology and Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.|Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: congenital heart disease; paediatric; transplantation; ventricular assist device