Does Small Size Matter With Continuous Flow Devices?: Analysis of the INTERMACS Database of Adults With BSA ≤1.5 m2.
This study investigated how small patient size affects clinical outcomes in patients implanted with a continuous flow left ventricular assist device (CFLVAD).



The development of smaller CFLVADs has allowed ventricular assist device (VAD) use in anatomically smaller patients; however, limited outcome data exist regarding CFLVAD use in patients with a body surface area (BSA) ≤1.5 m2.



All CFLVAD patients entered in the Interagency Registry for Mechanically Assisted Circulatory Support registry April 2008 to September 2013 and with BSA data were included. Biventricular VAD patients were excluded. Patient characteristics and clinical outcomes were compared between patients with BSA ≤1.5 m2(small patients) and those >1.5 m2.



Of 10,813 CFLVAD recipients, 231 had a BSA ≤1.5 m2. Small patients were more commonly female patients (68% vs. 20%; p < 0.01), Hispanic (10% vs. 6%; p < 0.03), and on intravenous inotropes (88% vs. 80%; p < 0.01). Small patients had higher bleeding (p < 0.01) and driveline infection (p < 0.01) rates, while exhibiting lower rates of right heart failure (p < 0.01) and renal dysfunction (p < 0.01). Device malfunction rate (p > 0.05), overall survival (p > 0.05), and 1-year competing outcomes (p > 0.05) were similar between BSA groups.



Patients with a BSA ≤1.5 m2supported with a CFLVAD have similar survival to larger patients. These data support the use of CFLVAD in anatomically small patients.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Farhan
F
Zafar
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Chet R
CR
Villa
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
David L
DL
Morales
Boston Children's Hospital, Boston, Massachusetts.
Elizabeth D
ED
Blume
Lucile Packard Children's Hospital, Palo Alto, California.
David N
DN
Rosenthal
University of Alabama at Birmingham, Birmingham, Alabama.
James K
JK
Kirklin
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: angela.lorts@cchmc.org.
Angela
A
Lorts
D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D049628:Body Size; D001830:Body Surface Area; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006470:Hemorrhage / Q000453:epidemiology; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
D002316:Cardiotonic Agents
INTERMACS; body surface area; continuous-flow pump; heart failure; ventricular assist device