title: United States Trends in Pediatric Ventricular Assist Implantation as Bridge to Transplantation.
abstract: Ventricular assist devices (VADs) are increasingly used to support children to heart transplant, however, it is unclear whether this trend is broadly applicable across the age/size spectrum. Children (≤18 years) listed for transplant were identified from the United Network of Organ Sharing (UNOS) database between January 2006 and May 2014. Patients were stratified by era (Early: 2006-2010, Current: 2011-2014), size (<25, 25-50, and >50 kg), and device type. Of 3,986 patients, 520 (13%) were supported by a VAD. The proportion of patients supported with a VAD has increased in the current era (16% vs. 11%, p < 0.001). The increase has occurred in children <25 kg (11% vs. 7%, p < 0.001) and >50 kg (26% vs. 17%, p < 0.002). Although VAD utilization was similar across eras in patients 25-50 kg (14% vs. 13%, p = 0.6), continuous flow VAD (cfVAD) use increased dramatically from 7% to 52% (p < 0.001). Waitlist outcome (p = 0.6) and posttransplant survival (p = 0.53) were similar between eras despite the shift to cfVADs in patients ≥25 kg. The emergence of cfVAD technology in an era of increasing waitlist times raises the prospect of an increasing population of children with cfVADs at home and in our communities.
authors.affiliation: From the *The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; and †Department of Family Medicine, University of Oklahoma, Tulsa, OK.
authors.forename: Chet R
authors.initials: CR
authors.lastname: Villa
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Khan
authors.forename: Farhan
authors.initials: F
authors.lastname: Zafar
authors.forename: David L S
authors.initials: DLS
authors.lastname: Morales
authors.forename: Angela
authors.initials: A
authors.lastname: Lorts
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D008297:Male; D014481:United States; D014850:Waiting Lists