Ventricular Assist Device Outcomes in Infants and Children With Stage 1 Single Ventricle Palliation

Anna Joong, Katsuhide Maeda, David M. Peng, Mohammed Absi, Blake P.N. Armstrong, Neha Bansal, David W. Bearl, Mark S. Bleiweis, Molly Brickler, Holger Buchholz, Sharon Chen, Jennifer Conway, Nhue L. Do, Paul Esteso, Joshua Friedland-Little, Eric R. Griffiths, Daphne T. Hsu, Steven J. Kindel, Angela Lorts, Hugo R. MartinezDavid Michael Mcmullan, Mary Mehegan, Deepa Mokshagundam, David L.S. Morales, Joseph Philip, Michelle Ploutz, David N. Rosenthal, Muhammad F. Shezad, Joshua Sparks, Courtney Ventresco, Chet Villa, Sarah Wilkens, Farhan Zafar

Research output: Contribution to journalArticlepeer-review

Abstract

Data on ventricular assist device (VAD) outcomes in infants with stage 1 single ventricle (SV) palliation are limited. We examined the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry for outcomes of pre/poststage 1 SV patients undergoing VAD implantation between March 2018 and October 2020. Data are collected from 32 centers and major adverse events undergo central adjudication. During the study period, 30 stage 1 SV patients underwent VAD implant with median age of 0.9 months (range 0.1-25) and weight 3.7 kg (2.4-17). Preimplant illness severity was high: ventilator support (90%), ECMO (30%), prior cerebral vascular accident (CVA, 23%), and dialysis (13%). Devices used included paracorporeal pulsatile (50%), paracorporeal continuous-flow (37%), and multiple devices (13%). Median support duration was 56 days (range 3-246). A positive clinical outcome (transplanted or weaned) was attained in 63% (63% transplanted, 37% mortality, 0% weaned). VAD adverse events included: major infection (43%), neurologic dysfunction (any = 30%; CVA = 20%), major bleeding (17%), renal dysfunction (13%), and device malfunction (3%). In conclusion, stage 1 SV patients undergoing VAD support have high preimplant illness severity and complexity, as well as significant morbidity and mortality postimplant. A variety of devices and strategies are employed by centers to support this challenging population.

Original languageEnglish (US)
Pages (from-to)E188-E195
JournalASAIO Journal
Volume68
Issue number11
DOIs
StatePublished - Nov 1 2022

Keywords

  • congenital heart disease
  • mechanical circulatory support
  • pediatrics
  • single ventricle
  • ventricular assist device

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

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