Heart-Assist Devices Bridge Gap to Transplant

Ventricular assist devices (VADs) successfully bridge the waiting period for heart transplantation in a majority of pediatric patients, according to a new study.

Researchers from Children's Hospital Boston (MA, USA) assessed the outcomes of 99 children awaiting heart transplantation between January 1993 and December 2003 who were given a VAD. The median age at VAD placement was 13.3 years and the most-common reason for transplantation was cardiomyopathy, which affected 78% of the patients, followed by congenital heart disease in 22%.

The average duration of VAD support was 57 days, and it ranged from one to 465 days. Seventy patients were supported by a long-term device, and 39% required biventricular support. Overall, 77% of patients were successfully bridged to heart transplantation, but in the last four years of the study, the rate climbed to 86%.

Seventeen patients died while awaiting transplantation. The risk of death was greatest in the first two weeks after receiving a VAD. Related risk factors included earlier implantation era, female gender, and congenital heart disease indication. The results were reported in the May 16, 2006, issue of Circulation.

"Bridging over 85% of patients successfully is really encouraging,” said lead author Dr. Elizabeth D. Blume. "It shows that, despite the fact that none of these devices were designed specifically for children, a group of smaller patients can take advantage of the adult technology and do as well, if not better.”

Extracorporeal membrane oxygenation has traditionally been used to bridge the gap to heart transplantation in children, but unfortunately the waiting period often exceeds the duration of support provided.



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Children's Hospital Boston