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Ventricular assist device implantation in children with a mechanical valve: An ACTION registry analysis

Background

Patients with congenital heart disease (CHD) frequently have had valve interventions, including replacement with a mechanical valve. The impact of a mechanical valve on clinical outcomes in patients undergoing ventricular assist device (VAD) implantation is not well characterized.

Objectives

This study assessed VAD outcomes in patients with CHD and a mechanical valve.

Methods

All patients with a history of CHD (n = 433) in the Advanced Cardiac Therapies Improving Outcomes Network database were included in the study (January 2012-January 2023). Patient characteristics and outcomes were assessed among patients with a mechanical valve and without a mechanical valve.

Results

Twenty-seven (6%) patients with CHD had a mechanical valve at VAD implantation. Fourteen (52%) of the patients with mechanical valve had univentricular anatomy and 13 (48%) had biventricular anatomy. Patients with mechanical valve were older (4.9 vs 1.9 years, p = 0.02), smaller (14.9 vs 10.6 kg, p = 0.02), and had a higher interagency registry for mechanically assisted circulatory support profile (p = 0.01). Three (11%) patients with mechanical valve experienced a valve-related complication. There was no difference in survival (p = 0.4) or ischemic stroke frequency (11% vs 13%, p = 1) between patients with mechanical valve and non-mechanical valve. Patients with mechanical valve had higher frequency of hemorrhagic stroke (18% vs 4.7%, p = 0.01) and major bleeding (44% vs 26%, p = 0.04).

Conclusions

Patients with CHD with a mechanical valve have similar survival to patients with non-mechanical valve; however, there is higher risk of bleeding including hemorrhagic stroke.

This ACTION study was available online in JHLT Open on December 19, 2024. Congratulations to the authors:

  • Sabena F. Hussain
  • Elyse Miller
  • Othman Aljohani
  • Scott Auerbach
  • David Bearl
  • Victor Benvenuto
  • Erica Bonura
  • Richard L. Crawford
  • Anna Joong
  • Jameson Dyal
  • Christina Hartje-Dunn
  • Sujit Jana
  • Sonia Kaushal
  • Melanie Lynn
  • Joseph Spinner
  • Laura Radel
  • Alexander Raskin
  • Diana Torpoco-Rivera
  • Sarah J. Wilkens
  • Chet R. Villa
CITATION

Hussain S, Miller E, et al. Ventricular assist device implantation in children with a mechanical valve: An ACTION registry analysis. JHLT Open 2025;7:100198; doi:10.1016/j.jhlto.2024.100198