JHLT Open (Feb 2025)

Ventricular assist device implantation in children with a mechanical valve: An ACTION registry analysis

  • Sabena F. Hussain, MD, MSc,
  • Elyse Miller, MD,
  • Othman Aljohani, MBBS, MPH,
  • Scott Auerbach, MD,
  • David Bearl, MD,
  • Victor Benvenuto, MD,
  • Erica Bonura, MD,
  • Richard L. Crawford,
  • Anna Joong, MD,
  • Jameson Dyal, MD,
  • Christina Hartje-Dunn, MD,
  • Sujit Jana, MD,
  • Sonia Kaushal, MD,
  • Melanie Lynn, MD,
  • Joseph Spinner, MD,
  • Laura Radel, MD,
  • Alexander Raskin, MD,
  • Diana Torpoco-Rivera, MD,
  • Sarah J. Wilkens, MD, MPH,
  • Chet R. Villa, MD

Journal volume & issue
Vol. 7
p. 100198

Abstract

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Background: Patients with congenital heart disease (CHD) frequently have had valve interventions, including replacement with a mechanical valve (mechV). The impact of a mechV on clinical outcomes in patients undergoing ventricular assist device (VAD) implantation is not well characterized. Objectives: This study assessed VAD outcomes in patients with CHD and a mechV. Methods: All patients with a history of CHD (n = 433) in the Advanced Cardiac Therapies Improving Outcomes Network database were included in the study (January 2012-January 2023). Patient characteristics and outcomes were assessed among patients with a mechV and without a mechV. Results: Twenty-seven (6%) patients with CHD had a mechV at VAD implantation. Fourteen (52%) of the patients with mechV had univentricular anatomy and 13 (48%) had biventricular anatomy. Patients with mechV were older (4.9 vs 1.9 years, p = 0.02), smaller (14.9 vs 10.6 kg, p = 0.02), and had a higher interagency registry for mechanically assisted circulatory support profile (p = 0.01). Three (11%) patients with mechV experienced a valve-related complication. There was no difference in survival (p = 0.4) or ischemic stroke frequency (11% vs 13%, p = 1) between patients with mechV and non-mechV. Patients with mechV had higher frequency of hemorrhagic stroke (18% vs 4.7%, p = 0.01) and major bleeding (44% vs 26%, p = 0.04). Conclusions: Patients with CHD with a mechV have similar survival to patients with non-mechV; however, there is higher risk of bleeding including hemorrhagic stroke.

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