End-organ recovery post-ventricular assist device can prognosticate survival☆

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Abstract

Background:

This study examines our institutional ventricular assist devices (VADs) experience over two decades to understand trends towards predictors of mortality.

Methods:

Retrospective study of patients aged 0–21 years supported with a VAD from January 1996 to May 2015. Patient data was examined pre and post-VAD implant among survivors and non-survivors.

Results:

Thirty-six patients identified (8 supported by Thoratec® VAD and 28 supported by EXCOR Berlin Heart®). Patient's diagnosis included dilated cardiomyopathy (DCM) (n = 19,53%), congenital heart disease (CHD) (n = 12,33%), and other (n = 5,14%). Median age and body surface area (BSA) were 1.0 years[0–7 years] and 0.41[0.24–0.92], respectively. Survival to discharge was 75% with no deaths with DCM. The survival rate for patients with CHD was 42%. Univariate analysis showed diagnosis of CHD, smaller BSA and respiratory failure post-implant (Intermacs criteria) as risk factors for mortality. Median duration of VAD support was lower in non-survivors, 14 vs 63 days (p = 0.03). Renal function at time of transplant or death was normal/pRIFLE Risk category in 20(74%) of survivors and 2(22%) of non-survivors (p = 0.06). Post-implant, peak total bilirubin in the first week trended lower in survivors (p = 0.06).

Conclusions:

Persistent end-organ impairment in the first 2 weeks after VAD placement could be a useful prognostic marker for survival to transplant.

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