Worldwide Experience of a Durable Centrifugal Flow Pump in Pediatric Patients

Pediatric VAD Investigators

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

The primary objectives of this study were to describe the characteristics and survival outcomes for children supported with the HeartWare HVAD® system from the global community. This was a retrospective survey of patients <18 years of age with an HVAD® system. Questionnaires were sent to sites worldwide in April 2015 and collected between May 2015 and 2016. Information on 205 patients was collected. The median age at implantation was 13.1 years (interquartile range [IQR] 9.8-15.8 years) and the weight was 42 kg (IQR 28–60 kg). Over half of the implants occurred in males (61%), with the most common diagnosis being cardiomyopathy (n = 168, 82%). The majority of HVAD® systems implanted were left ventricular assist device (n = 189, 92.2%). Temporary right ventricular support was utilized in 24 patients (12%) with a median duration of 12 days (6-32 days). Fifty-five percent (n = 111) of the patients were discharged home after implantation after a median (IQR) duration of hospital stay of 40 days (28-71 days). By 12 months, the proportion of patients who underwent heart transplant was 65.4%, 10.7% had died, 3.2% were explanted for recovery, and 20.8% remained on the device. Death on the device on multivariable analysis was associated with the need for temporary RV support (hazard ratio [HR] 10.65 (95% CI 12.53-44.81), P = 0.001) and pump exchange (HR 7.9 (95% CI 1.8-34.2], P = 0.006). The use of the HeartWare HVAD system in the pediatric population is associated with mortality with the majority of patients supported to heart transplant by 1 year post implant. These positive results are independent of geographic location. The need for a temporary right heart support and pump exchange is associated with a higher risk of poor outcomes, and further work is required to predict these patients to allow for optimization. Although survival results are promising, further studies are needed to delineate the associated morbidities with this technology in the pediatric population.

Original languageEnglish (US)
JournalSeminars in Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Pediatrics
Transplants
Geographic Locations
Equipment and Supplies
Heart-Assist Devices
Survival
Cardiomyopathies
Population
Length of Stay
Technology
Morbidity
Weights and Measures
Mortality
Surveys and Questionnaires

Keywords

  • children
  • continuous-flow pumps
  • outcomes
  • ventricular assist devices

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Worldwide Experience of a Durable Centrifugal Flow Pump in Pediatric Patients. / Pediatric VAD Investigators.

In: Seminars in Thoracic and Cardiovascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Worldwide Experience of a Durable Centrifugal Flow Pump in Pediatric Patients",
abstract = "The primary objectives of this study were to describe the characteristics and survival outcomes for children supported with the HeartWare HVAD{\circledR} system from the global community. This was a retrospective survey of patients <18 years of age with an HVAD{\circledR} system. Questionnaires were sent to sites worldwide in April 2015 and collected between May 2015 and 2016. Information on 205 patients was collected. The median age at implantation was 13.1 years (interquartile range [IQR] 9.8-15.8 years) and the weight was 42 kg (IQR 28–60 kg). Over half of the implants occurred in males (61{\%}), with the most common diagnosis being cardiomyopathy (n = 168, 82{\%}). The majority of HVAD{\circledR} systems implanted were left ventricular assist device (n = 189, 92.2{\%}). Temporary right ventricular support was utilized in 24 patients (12{\%}) with a median duration of 12 days (6-32 days). Fifty-five percent (n = 111) of the patients were discharged home after implantation after a median (IQR) duration of hospital stay of 40 days (28-71 days). By 12 months, the proportion of patients who underwent heart transplant was 65.4{\%}, 10.7{\%} had died, 3.2{\%} were explanted for recovery, and 20.8{\%} remained on the device. Death on the device on multivariable analysis was associated with the need for temporary RV support (hazard ratio [HR] 10.65 (95{\%} CI 12.53-44.81), P = 0.001) and pump exchange (HR 7.9 (95{\%} CI 1.8-34.2], P = 0.006). The use of the HeartWare HVAD system in the pediatric population is associated with mortality with the majority of patients supported to heart transplant by 1 year post implant. These positive results are independent of geographic location. The need for a temporary right heart support and pump exchange is associated with a higher risk of poor outcomes, and further work is required to predict these patients to allow for optimization. Although survival results are promising, further studies are needed to delineate the associated morbidities with this technology in the pediatric population.",
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author = "{Pediatric VAD Investigators} and Jennifer Conway and Oliver Miera and Iki Adachi and Katsuhide Maeda and Pirooz Eghtesady and Henderson, {Heather T.} and Kristine Guleserian and Fan, {Chu Po S.} and Richard Kirk and Canter, {Charles E.} and Mustafa Pac and Christina VanderPluym and Lucas Eastaugh and Holger Buchholz and Daniel Zimpfer and Joseph Turek and Matthew Fenton and Neibler, {Robert A.} and Kirklin, {James K.} and Padalino, {Massimo A.} and Angela Lorts and Mohamed Hassan and Irene Lytrivi and Scott Auerbach and Slaughter, {Mark S.} and Martin Schweiger and Takayoshi Ueno and Davies, {Ryan R.} and Lamour, {Jacqueline M.} and Schmitto, {Jan D.} and Matthew Zinn and Derek Human and Scheel, {Janet N.} and Yijiang Li and Parrino, {Patrick E.} and {Borik Chiger}, Sharon and Brigitte Stiller and Julia Dumfarth and Morales, {David L.}",
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AU - Pediatric VAD Investigators

AU - Conway, Jennifer

AU - Miera, Oliver

AU - Adachi, Iki

AU - Maeda, Katsuhide

AU - Eghtesady, Pirooz

AU - Henderson, Heather T.

AU - Guleserian, Kristine

AU - Fan, Chu Po S.

AU - Kirk, Richard

AU - Canter, Charles E.

AU - Pac, Mustafa

AU - VanderPluym, Christina

AU - Eastaugh, Lucas

AU - Buchholz, Holger

AU - Zimpfer, Daniel

AU - Turek, Joseph

AU - Fenton, Matthew

AU - Neibler, Robert A.

AU - Kirklin, James K.

AU - Padalino, Massimo A.

AU - Lorts, Angela

AU - Hassan, Mohamed

AU - Lytrivi, Irene

AU - Auerbach, Scott

AU - Slaughter, Mark S.

AU - Schweiger, Martin

AU - Ueno, Takayoshi

AU - Davies, Ryan R.

AU - Lamour, Jacqueline M.

AU - Schmitto, Jan D.

AU - Zinn, Matthew

AU - Human, Derek

AU - Scheel, Janet N.

AU - Li, Yijiang

AU - Parrino, Patrick E.

AU - Borik Chiger, Sharon

AU - Stiller, Brigitte

AU - Dumfarth, Julia

AU - Morales, David L.

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N2 - The primary objectives of this study were to describe the characteristics and survival outcomes for children supported with the HeartWare HVAD® system from the global community. This was a retrospective survey of patients <18 years of age with an HVAD® system. Questionnaires were sent to sites worldwide in April 2015 and collected between May 2015 and 2016. Information on 205 patients was collected. The median age at implantation was 13.1 years (interquartile range [IQR] 9.8-15.8 years) and the weight was 42 kg (IQR 28–60 kg). Over half of the implants occurred in males (61%), with the most common diagnosis being cardiomyopathy (n = 168, 82%). The majority of HVAD® systems implanted were left ventricular assist device (n = 189, 92.2%). Temporary right ventricular support was utilized in 24 patients (12%) with a median duration of 12 days (6-32 days). Fifty-five percent (n = 111) of the patients were discharged home after implantation after a median (IQR) duration of hospital stay of 40 days (28-71 days). By 12 months, the proportion of patients who underwent heart transplant was 65.4%, 10.7% had died, 3.2% were explanted for recovery, and 20.8% remained on the device. Death on the device on multivariable analysis was associated with the need for temporary RV support (hazard ratio [HR] 10.65 (95% CI 12.53-44.81), P = 0.001) and pump exchange (HR 7.9 (95% CI 1.8-34.2], P = 0.006). The use of the HeartWare HVAD system in the pediatric population is associated with mortality with the majority of patients supported to heart transplant by 1 year post implant. These positive results are independent of geographic location. The need for a temporary right heart support and pump exchange is associated with a higher risk of poor outcomes, and further work is required to predict these patients to allow for optimization. Although survival results are promising, further studies are needed to delineate the associated morbidities with this technology in the pediatric population.

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