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Bridge to Transplant with Ventricular Assist Device Support in Pediatric Patients with Single Ventricle Heart Disease

Chen, Sharon*; Rosenthal, David N.*; Murray, Jenna; Dykes, John C.*; Almond, Christopher S.*; Yarlagadda, Vamsi V.*; Wright, Gail*; Navaratnam, Manchula; Reinhartz, Olaf§; Maeda, Katsuhide§

doi: 10.1097/MAT.0000000000000983
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Ventricular assist device (VAD) support for children with single ventricle (SV) heart disease remains challenging. We performed a single-center retrospective review of SV patients on VAD support and examined survival to transplant using the Kaplan–Meier method. Patients transplanted were compared with those who died on support. Between 2009 and 2017, there were 14 SV patients with 1,112 patient-days of VAD support. Stages of palliation included pre-Glenn (n = 5), Glenn (n = 5), and Fontan (n = 4). Eight patients (57%) were successfully bridged to transplant at a median 107 days. Deaths occurred early (n = 6, median 16 days) and in smaller patients (10.1 vs. 28.3 kg, P = 0.04). All Fontan patients survived to transplant, whereas only 20% of Glenn patients survived to transplant. Adverse events occurred in 79% (n = 11). Five patients met hospital discharge criteria, with two patients (one pre-Glenn, one Glenn) discharged and transplanted after 219 and 174 days of VAD support. All transplanted patients were discharged at a median 21 days posttransplant. SV patients in various stages of palliation can be successfully bridged to transplant with VAD support. With use of intracorporeal continuous-flow devices, longer-term support and hospital discharge are possible.

From the *Division of Pediatric Cardiology, Stanford University, Palo Alto, California

Lucile Packard Children’s Hospital, Palo Alto, California

Department of Anesthesia, Stanford University, Palo Alto, California

§Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.

Submitted for consideration July 2018; accepted for publication in revised form February 2019.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Sharon Chen, 750 Welch Road, Suite 305, Palo Alto, CA 94304. Email: shchen@stanford.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs