Multicenter outcomes for ventricular assist device support for failed stage II palliation
Edon J. Rabinowitz, MD,
Mary Mehegan, RN,
Anna Joong, MD,
Muhammad Shezad, MHSA,
Angela Lorts, MD,
Chet R. Villa, MD,
Jennifer Conway, MD, MSc,
Ryan Kobayashi, MD,
Scott R. Auerbach, MD,
Matthew Zinn, DO,
Robert Niebler, MD,
Mehreen Iqbal, MD,
John Dykes, MD,
Swati Choudhry, MD,
Othman Aljohani, MD,
Mohammed Absi, MD,
Michelle S. Ploutz, MD,
Eric R. Griffiths, MD,
Matthew J. O’Connor, MD,
Deepa Mokshagundam, MD,
Ahmed S. Said, MD, PhD
Affiliations
Edon J. Rabinowitz, MD
Division of Pediatric Critical Care Medicine, Washington University in St Louis, St Louis, Missouri; Division of Pediatric Cardiology, Washington University in St Louis, St Louis, Missouri; *Corresponding author: Edon J. Rabinowitz, MD, Pediatric Critical Care and Cardiology, Washington University in St. Louis, 660 S. Euclid Ave, MSC 8208-0016-01, St. Louis, MO 63110.
Mary Mehegan, RN
Division of Pediatric Cardiology, Washington University in St Louis, St Louis, Missouri
Anna Joong, MD
Division of Pediatric Cardiology, Lurie Children’s Hospital, Chicago, Illinois
Muhammad Shezad, MHSA
The Heart Institute, Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio
Angela Lorts, MD
The Heart Institute, Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio
Chet R. Villa, MD
The Heart Institute, Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio
Jennifer Conway, MD, MSc
Division of Pediatric Cardiology, Stollery Children’s Hospital, Edmonton, Alberta, Canada
Ryan Kobayashi, MD
Division of Pediatric Cardiology, Boston Children’s Hospital, Boston, Massachusetts
Scott R. Auerbach, MD
Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, Colorado
Matthew Zinn, DO
Division of Pediatric Cardiology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
Robert Niebler, MD
Medical College of Wisconsin, Department of Pediatrics, Section of Critical Care, Milwaukee, Wisconsin
Mehreen Iqbal, MD
Division of Pediatric Cardiology, Children’s Medical Center Dallas, Dallas, Texas
John Dykes, MD
Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Palo Alto, California
Swati Choudhry, MD
Division of Pediatric Cardiology, Texas Children’s Hospital, Houston, Texas
Othman Aljohani, MD
Division of Pediatric Cardiology, Benioff Children’s Hospital, San Francisco, California
Mohammed Absi, MD
Heart Institute, Le Bonheur Children’s Hospital, University of Tennessee, Memphis, Tennessee
Michelle S. Ploutz, MD
Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
Eric R. Griffiths, MD
Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
Matthew J. O’Connor, MD
Division of Pediatric Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Deepa Mokshagundam, MD
Division of Pediatric Cardiology, Washington University in St Louis, St Louis, Missouri
Ahmed S. Said, MD, PhD
Division of Pediatric Critical Care Medicine, Washington University in St Louis, St Louis, Missouri
Background: Ventricular assist device (VAD) use for failed stage II palliation (S2P) is increasing with limited data on outcomes. Methods: To address this knowledge gap, we conducted a multicenter retrospective review of the Advanced Cardiac Therapies Improving Outcomes Network registry. We leveraged the registry to analyze data on the clinical course, complications, and survival of systemic VADs (SVAD) after S2P. Results: We identified 34 patients from 15 centers between 2012 and 2022 implanted at median age of 1.8 years [interquartile range (IQR) 0.9-2.7]; 85% had systemic right ventricles and all patients underwent at least one sternotomy. Preimplant, all but 1 patient had an Interagency Registry for Mechanically Assisted Circulatory Support profile of 1-2, with 62% being on ≥2 inotropes, 50% total parenteral nutrition dependent, 38% mechanically ventilated, and 20% on extracorporeal membrane oxygenation in the week preceding implant. Device strategy was variable with 70% being on continuous flow devices and the remaining on pulsatile support. Multiple device strategies were utilized in 32% of patients. Median time on VAD support was 74 days [IQR 30-186]. Adverse events were frequent and included infection (47%), strokes (29%), bleeding (26%), dialysis (15%), and respiratory failure (9%). Bleeding complications (p = 0.0004), respiratory failure (p = 0.04), and multiple inotropes preimplant (p = 0.046) were associated with in-hospital mortality. Overall survival to transplant/recovery was seen in 76% and to 1-year postexplant in 56%. Conclusion: Encouraging clinical outcomes are seen with SVAD use for failed S2P even in the face of frequent adverse events and wide center variability in device strategy. Ongoing multi-institutional collaboration is required to better understand optimal SVAD support strategies.
