Advanced Heart Function and pHeart Transplant Fellow The Stollery Children's Hospital The University of Alberta Edmonton, Alberta, Canada
Background: Outcomes of Ventricular Assist Device (VAD) implantation in the pediatric population are well described. However, little is known about patients who have been referred for a VAD. Timely referral and evaluation are essential for optimal outcomes. The purpose of this study was to describe the clinical outcomes of pediatric patients following the initial VAD consultation.
METHODS AND RESULTS:
Methods: Retrospective analysis for patients referred to our VAD services between 01/2019 and 12/2023. Outcomes were reported at 30-days and 1-year post consult. Patients who died, were too unwell for VAD or required ECMO within 30-days of consultation were considered acute referrals. Multivariate logistic regression analysis was used to determine risk factors for being an acute referral.
Results: There were 128 patients included, with median age at referral 2.7years (IQR 0.3, 0.9), 50.8% being male and 52.3% of patients having congenital heart disease (CHD). The primary indication for VAD consult was due to patient undergoing a transplant evaluation. At 30-days 31% (n=41) were considered acute referrals, with 28.1% (n=36) receiving ECMO, 3.1% (n=4) being too unwell for VAD and 0.8% (n=1) patients dying. Of those that were classified as acute referrals, 56.1% could potentially have been predicted. At 30-days post referral most acute referrals had been implanted with a VAD, while most elective referrals were too well for VAD support (Figure 1). Patients who were acute referrals and had not received VAD therapy or transplant had worse 1-year survival (p < 0.001) then elective referrals, with the highest risk for mortality being early in the course (Figure 2). Diagnosis of biventricular CHD, other (non-CHD, non-cardiomyopathy) or absence of comorbidities were independent factors associated with being an acute referral.
Conclusion: Of patients referred to the VAD service, one-third were considered acute referrals. Patients who were acute referrals had increased 1-year mortality then those who were elective referrals. This study highlights the fact we have the opportunity to improve referral patterns, with the goal of reducing the proportion of patients who are acutely referred. Factors associated with being an acute referral included diagnosis of biventricular CHD or other (non CHD non cardiomyopathy), and no comorbidities.
