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