Can early improvement after VAD implant positively affect outcomes? This study describes the clinical status of pediatric patients supported with a VAD and determines how clinical status at 1-month follow-up impacts survival and ability to discharge.
The retrospective analysis follows 414 patients implanted between September 19, 2012, and September 30, 2019 who were alive on either a paracorporeal pulsatile or intracorporeal continuous device at 1-month post-implant. 85.5% of patients had an LVAD, and 68% had cardiomyopathy.
Findings at implant:
- 40% were ventilated
- 57% required nutritional support
- 93% were on inotropes
- 58% were non-ambulating
Findings on the 1-month post-implant form:
- 14% were ventilated
- 46% required nutritional support
- 53% were on inotropes
- 25% were non-ambulating
There were significant improvements in the presence of mechanical ventilation, supplemental nutritional support, inotropic support, and ambulatory status 1-month post-implant. However, the percentage of patients requiring supplemental nutrition in the paracorporeal pulsatile devices was 88% vs. 82%.
Overall, presence of these four parameters after VAD placement had a significant negative impact on survival and on the ability of patients with continuous-flow devices to be discharged. Optimization of patients before implant is needed, and aggressive rehabilitation after implant is needed to help improve long-term outcomes.
Several ACTION members and institutions were involved:
- Jennifer Conway, Stollery Children’s Hospital
- William Ravekes, Johns Hopkins
- Patrick McConnell, Nationwide Children’s Hospital
- Daphne Hsu, Children’s Hospital at Montefiore
Conway J, Ravekes W, McConnell P, Cantor RS, Koehl D, Sun B, Daly RC, Hsu DT. Early Improvement in Clinical Status Following Ventricular Assist Device Implantation in Children: A Marker for Survival. ASAIO J. 2021 Apr 7. doi: 10.1097/MAT.0000000000001420. Epub ahead of print. PMID: 33852494.