Impact Of Ventricular Assist Device Use On Pediatric Heart Transplant Outcomes In A Linked Cohort Of The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) And Pediatric Heart Transplant Society (PHTS) Databases.

Purpose

Pediatric ventricular assist devices (VAD) improve waitlist mortality. We aimed to compare outcomes after heart transplant (HT) based on pre-HT support in patients <18 years at listing.

Methods

VAD and post-HT data were linked between ACTION and PHTS databases, respectively (4/1/2018-6/30/2022). Support groups were defined as medical (MG) and VAD (VG). Within VG, device groups were defined as paracorporeal pulsatile (PP), paracorporeal continuous (PC), and implantable continuous (IC). Kaplan-Meier analysis, the log rank test, and Cox proportional hazards modeling analyzed graft loss post-HT, with and without propensity matching.

Results

The 1360 patients included VG=405 and MG=955. At HT, VG was younger (4.2 [0.8-13.3 vs 6.1 [0.9-16.7] years; p=0.03) and more likely to receive mechanical ventilation (15.3% vs 11.0%; p=0.03). The proportion of congenital heart disease (CHD) was higher in MG (64.8%) vs VG (35.1%; p<0.0001). Overall graft survival did not differ between VG and MG (p=0.17). In unmatched multivariable analysis, PC and PP devices, CHD, Black or Other race, mechanical ventilation at transplant, and absence of induction therapy were independently associated with graft loss (all p<0.05), while VG was associated with lower risk of post-HT infection (HR 0.75 [95% CI 0.56-0.99]). In propensity-matched cohorts, VAD was not associated with graft loss. Within VG, VAD major adverse events of infection, bleeding, and respiratory failure were associated with inferior post-HT outcomes.

Conclusion

VAD support was not associated with graft loss after propensity matching. Differences by device type in unmatched analyses likely reflect differences in patient complexity rather than device-specific effects.