Outpatient Management of Intra-Corporeal Left Ventricular Assist Device System in Children: A Multi-Center Experience
Little is known about the outcomes of children supported on intracorporeal left ventricular assist device (HVAD), and the feasibility of outpatient management. All centers with pediatric patients discharged from the hospital on the device were identified using company database. A total of 14 centers were contacted, with 9 centers, contributing data retrospectively. From 2011 to 2013, 12 pediatric patients (7 females), mean aged 11.9 ± 2.3 years (range 8–15), mean weight 43 ± 19 kg (range 18–81), mean body surface area 1.3 ± 0.3 m2 (range 0.76–1.96) were identified. Diagnosis included: dilated cardiomyopathy (CMP) (n = 5), noncompaction CMP (n = 4), toxic CMP (n = 2) and viral CMP (n = 1). Indications for support were permanent support (n = 1), bridge to recovery (n = 1) and bridge to transplantation (n = 10). Prior to HVAD implantation, all patients received intravenous inotropes and two patients were on temporary mechanical support. Overall mortality was 0%. Mean duration of inpatient and outpatient support were 56 (range: 19–95 days) and 290 days (range: 42–790), respectively. Mean readmission rate was 0.02 per patient month (2.1 per patient). No adverse events involving emergency department occurred. Eight children resumed local schooling. Home discharge of children supported on HVAD is feasible and safe. School integration can be achieved. There is wide center variability to discharge practice for children.
The authors report their retrospective multicenter experience on the feasibility and safe outpatient management of children supported by intra-corporeal left ventricular assist devices, including discharge practices and school integration, with 0% mortality and a readmission rate of 0.02 per patient.