United States Trends in Pediatric Ventricular Assist Implantation as Bridge to Transplantation


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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.

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