Post-transplant outcomes of children bridged to transplant with the berlin heart EXCOR pediatric ventricular assist device

Pirooz Eghtesady, Christopher S D Almond, Christine Tjossem, Deirdre Epstein, Michiaki Imamura, Mark Turrentine, James Tweddell, Robert D B Jaquiss, Charles Canter

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

BACKGROUND - Recent data suggest that Berlin Heart EXCOR Pediatric (EXCOR) ventricular assist device improves waiting list survival for pediatric heart transplant candidates. Little is known about their post-transplant outcomes. The aim of this analysis was to determine whether there was a difference in early survival for children bridged to transplant with EXCOR versus status 1A pediatric heart transplant patients not transplanted with ventricular assist device support. METHODS AND RESULTS - Pediatric heart transplant patients (n=106) bridged to transplantation with EXCOR were compared with a similarly aged cohort (n=1021) within the Organ Procurement and Transplant Network (OPTN) database (both cohorts from May 2007 to December 2010). In the EXCOR group, 12-month post-transplant survival (88.7%) was similar to OPTN patients listed status 1A who were not on ventricular assist device support at transplant (89.3%; P=0.85) and significantly better than 12-month survival in OPTN patients on extracorporeal membrane oxygenation at transplant (60.3%; P<0.001). Rejection (50%) was a significantly (P=0.005) higher cause of 12-month post-transplant mortality in the EXCOR compared with the OPTN group. Death after transplant was also higher in EXCOR patients with congenital heart disease compared with those with cardiomyopathy (26.1% versus 7.2%; P=0.02). Post-transplant survival was similar in EXCOR patients with ≥1 serious adverse event during ventricular assist device support as those without an event during support. CONCLUSIONS - The 12-month post-transplant survival with EXCOR is comparable with overall pediatric heart transplant survival and superior to survival after extracorporeal membrane oxygenation. Neither adverse events during support nor factors associated with mortality during support influence post-transplant survival. Rejection was a significantly greater cause of post-transplant mortality in EXCOR than in OPTN patients.

Original languageEnglish
JournalCirculation
Volume128
Issue numberSUPPL.1
DOIs
StatePublished - Sep 10 2013

Fingerprint

Heart-Assist Devices
Berlin
Pediatrics
Transplants
Tissue and Organ Procurement
Extracorporeal Membrane Oxygenation
Survival
Mortality

Keywords

  • Heart failure
  • Heart-assist device
  • Pediatrics
  • Surgery
  • Transplantation

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Post-transplant outcomes of children bridged to transplant with the berlin heart EXCOR pediatric ventricular assist device. / Eghtesady, Pirooz; Almond, Christopher S D; Tjossem, Christine; Epstein, Deirdre; Imamura, Michiaki; Turrentine, Mark; Tweddell, James; Jaquiss, Robert D B; Canter, Charles.

In: Circulation, Vol. 128, No. SUPPL.1, 10.09.2013.

Research output: Contribution to journalArticle

Eghtesady, P, Almond, CSD, Tjossem, C, Epstein, D, Imamura, M, Turrentine, M, Tweddell, J, Jaquiss, RDB & Canter, C 2013, 'Post-transplant outcomes of children bridged to transplant with the berlin heart EXCOR pediatric ventricular assist device', Circulation, vol. 128, no. SUPPL.1. https://doi.org/10.1161/CIRCULATIONAHA.112.000446
Eghtesady, Pirooz ; Almond, Christopher S D ; Tjossem, Christine ; Epstein, Deirdre ; Imamura, Michiaki ; Turrentine, Mark ; Tweddell, James ; Jaquiss, Robert D B ; Canter, Charles. / Post-transplant outcomes of children bridged to transplant with the berlin heart EXCOR pediatric ventricular assist device. In: Circulation. 2013 ; Vol. 128, No. SUPPL.1.
@article{d5005d40cbf847779fbc25399452633c,
title = "Post-transplant outcomes of children bridged to transplant with the berlin heart EXCOR pediatric ventricular assist device",
abstract = "BACKGROUND - Recent data suggest that Berlin Heart EXCOR Pediatric (EXCOR) ventricular assist device improves waiting list survival for pediatric heart transplant candidates. Little is known about their post-transplant outcomes. The aim of this analysis was to determine whether there was a difference in early survival for children bridged to transplant with EXCOR versus status 1A pediatric heart transplant patients not transplanted with ventricular assist device support. METHODS AND RESULTS - Pediatric heart transplant patients (n=106) bridged to transplantation with EXCOR were compared with a similarly aged cohort (n=1021) within the Organ Procurement and Transplant Network (OPTN) database (both cohorts from May 2007 to December 2010). In the EXCOR group, 12-month post-transplant survival (88.7{\%}) was similar to OPTN patients listed status 1A who were not on ventricular assist device support at transplant (89.3{\%}; P=0.85) and significantly better than 12-month survival in OPTN patients on extracorporeal membrane oxygenation at transplant (60.3{\%}; P<0.001). Rejection (50{\%}) was a significantly (P=0.005) higher cause of 12-month post-transplant mortality in the EXCOR compared with the OPTN group. Death after transplant was also higher in EXCOR patients with congenital heart disease compared with those with cardiomyopathy (26.1{\%} versus 7.2{\%}; P=0.02). Post-transplant survival was similar in EXCOR patients with ≥1 serious adverse event during ventricular assist device support as those without an event during support. CONCLUSIONS - The 12-month post-transplant survival with EXCOR is comparable with overall pediatric heart transplant survival and superior to survival after extracorporeal membrane oxygenation. Neither adverse events during support nor factors associated with mortality during support influence post-transplant survival. Rejection was a significantly greater cause of post-transplant mortality in EXCOR than in OPTN patients.",
keywords = "Heart failure, Heart-assist device, Pediatrics, Surgery, Transplantation",
author = "Pirooz Eghtesady and Almond, {Christopher S D} and Christine Tjossem and Deirdre Epstein and Michiaki Imamura and Mark Turrentine and James Tweddell and Jaquiss, {Robert D B} and Charles Canter",
year = "2013",
month = "9",
day = "10",
doi = "10.1161/CIRCULATIONAHA.112.000446",
language = "English",
volume = "128",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "SUPPL.1",

}

TY - JOUR

T1 - Post-transplant outcomes of children bridged to transplant with the berlin heart EXCOR pediatric ventricular assist device

AU - Eghtesady, Pirooz

AU - Almond, Christopher S D

AU - Tjossem, Christine

AU - Epstein, Deirdre

AU - Imamura, Michiaki

AU - Turrentine, Mark

AU - Tweddell, James

AU - Jaquiss, Robert D B

AU - Canter, Charles

PY - 2013/9/10

Y1 - 2013/9/10

N2 - BACKGROUND - Recent data suggest that Berlin Heart EXCOR Pediatric (EXCOR) ventricular assist device improves waiting list survival for pediatric heart transplant candidates. Little is known about their post-transplant outcomes. The aim of this analysis was to determine whether there was a difference in early survival for children bridged to transplant with EXCOR versus status 1A pediatric heart transplant patients not transplanted with ventricular assist device support. METHODS AND RESULTS - Pediatric heart transplant patients (n=106) bridged to transplantation with EXCOR were compared with a similarly aged cohort (n=1021) within the Organ Procurement and Transplant Network (OPTN) database (both cohorts from May 2007 to December 2010). In the EXCOR group, 12-month post-transplant survival (88.7%) was similar to OPTN patients listed status 1A who were not on ventricular assist device support at transplant (89.3%; P=0.85) and significantly better than 12-month survival in OPTN patients on extracorporeal membrane oxygenation at transplant (60.3%; P<0.001). Rejection (50%) was a significantly (P=0.005) higher cause of 12-month post-transplant mortality in the EXCOR compared with the OPTN group. Death after transplant was also higher in EXCOR patients with congenital heart disease compared with those with cardiomyopathy (26.1% versus 7.2%; P=0.02). Post-transplant survival was similar in EXCOR patients with ≥1 serious adverse event during ventricular assist device support as those without an event during support. CONCLUSIONS - The 12-month post-transplant survival with EXCOR is comparable with overall pediatric heart transplant survival and superior to survival after extracorporeal membrane oxygenation. Neither adverse events during support nor factors associated with mortality during support influence post-transplant survival. Rejection was a significantly greater cause of post-transplant mortality in EXCOR than in OPTN patients.

AB - BACKGROUND - Recent data suggest that Berlin Heart EXCOR Pediatric (EXCOR) ventricular assist device improves waiting list survival for pediatric heart transplant candidates. Little is known about their post-transplant outcomes. The aim of this analysis was to determine whether there was a difference in early survival for children bridged to transplant with EXCOR versus status 1A pediatric heart transplant patients not transplanted with ventricular assist device support. METHODS AND RESULTS - Pediatric heart transplant patients (n=106) bridged to transplantation with EXCOR were compared with a similarly aged cohort (n=1021) within the Organ Procurement and Transplant Network (OPTN) database (both cohorts from May 2007 to December 2010). In the EXCOR group, 12-month post-transplant survival (88.7%) was similar to OPTN patients listed status 1A who were not on ventricular assist device support at transplant (89.3%; P=0.85) and significantly better than 12-month survival in OPTN patients on extracorporeal membrane oxygenation at transplant (60.3%; P<0.001). Rejection (50%) was a significantly (P=0.005) higher cause of 12-month post-transplant mortality in the EXCOR compared with the OPTN group. Death after transplant was also higher in EXCOR patients with congenital heart disease compared with those with cardiomyopathy (26.1% versus 7.2%; P=0.02). Post-transplant survival was similar in EXCOR patients with ≥1 serious adverse event during ventricular assist device support as those without an event during support. CONCLUSIONS - The 12-month post-transplant survival with EXCOR is comparable with overall pediatric heart transplant survival and superior to survival after extracorporeal membrane oxygenation. Neither adverse events during support nor factors associated with mortality during support influence post-transplant survival. Rejection was a significantly greater cause of post-transplant mortality in EXCOR than in OPTN patients.

KW - Heart failure

KW - Heart-assist device

KW - Pediatrics

KW - Surgery

KW - Transplantation

UR - http://www.scopus.com/inward/record.url?scp=84883805851&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84883805851&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.112.000446

DO - 10.1161/CIRCULATIONAHA.112.000446

M3 - Article

C2 - 24030413

AN - SCOPUS:84883805851

VL - 128

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - SUPPL.1

ER -