1
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Peng DM, Yu S, Lowery R, Ventresco C, Cousino MK, St Louis JD, Blume ED, Uzark K. Self-reported quality of life in children with ventricular assist devices. Pediatr Transplant 2022; 26:e14237. [PMID: 35102660 DOI: 10.1111/petr.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND We sought to describe QOL in children with VAD and to identify factors associated with impaired QOL. METHODS There were 82 children (6-19 years) in the Pediatric Interagency Registry for Mechanical Circulatory Support who completed the PedsQL +/- a VAD-specific QOL assessment pre-VAD implant (n = 18), 3 months post-VAD (n = 63), and/or 6 months post-VAD (n = 38). Significantly impaired QOL is a score >1 SD below norms. RESULTS Study patients were 59% male, 67% Caucasian, with cardiomyopathy diagnosis in 82%, and median age at implant of 14 y (IQR 11-17). PedsQL scores were lower than norms for physical (p < .0001) and psychosocial (p < .01) QOL in pre- and post-VAD groups. Compared to chronic health condition and complex or severe heart disease groups, PedsQL scores were lower for physical and psychosocial QOL in the pre-VAD group (p < .0001); however, psychosocial QOL was not significantly different in post-VAD groups. Psychosocial QOL was impaired in 67%, 40%, and 24% in pre-VAD, 3-month, and 6-month post-VAD groups, respectively. Total and psychosocial QOL scores were significantly higher in the 3-month and 6-month post-VAD group than pre-VAD (all p ≤ .02). VAD patients were most bothered by their inability to participate in usual play activities. Impaired QOL 3 months post-VAD was associated with inotropic support >2 weeks/ongoing post-VAD (p = .04). CONCLUSION Physical QOL is significantly impaired in most children pre- and post-VAD. However, psychosocial QOL is not significantly impaired in most children post-VAD suggesting VAD implantation may improve psychosocial QOL in children.
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Affiliation(s)
- David M Peng
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Sunkyung Yu
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Ray Lowery
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Courtney Ventresco
- Department of Cardiology, Boston Children's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Melissa K Cousino
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - James D St Louis
- Department of Surgery, Medical College of Georgia, Children's Hospital of Georgia, Augusta, Georgia, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Karen Uzark
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
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2
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Rea KE, McCormick AM, Lim HM, Cousino MK. Psychosocial outcomes in pediatric patients with ventricular assist devices and their families: A systematic review. Pediatr Transplant 2021; 25:e14001. [PMID: 33704884 PMCID: PMC8141009 DOI: 10.1111/petr.14001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
Ventricular assist device (VAD) therapy has provided pediatric patients with severe heart failure new therapeutic options. However, pediatric patients and families receiving VAD therapy also experience psychosocial challenges. No synthesis of the literature on psychosocial outcomes within the pediatric VAD population has been conducted; thus, the current review sought to systematically investigate the impact of pediatric VAD on patient, parent, and family psychosocial outcomes and assess variables associated with poorer outcomes. Literature searches were conducted in PsycInfo, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases and full texts were assessed according to pre-established inclusion criteria. Main findings and study quality were reviewed. Sixteen studies were included in the present review. Findings highlighted the likelihood for psychological sequelae among pediatric patients and families receiving VAD therapy, including decreased psychological and emotional well-being, elevated stress, and difficulty coping with changes to family dynamics and responsibilities. Health-related quality of life was reported comparable to that of healthy peers and children with other cardiac conditions. Patients and families on VAD therapy experience significant difficulties in psychological well-being and challenges related to adjustment. The current review underscores the importance of ongoing support for families and continued assessment of psychosocial functioning across VAD support. Three critical periods for increased distress were identified: 1) immediately following VAD implantation, 2) discharge home and the weeks following discharge, and 3) long-term VAD therapy.
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Affiliation(s)
| | | | - Heang M. Lim
- Department of Pediatrics, Michigan Medicine, University of Michigan
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3
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Garcia Guerra G, Bond GY, Joffe AR, Dinu IA, Hajihosseini M, Al-Aklabi M, Robertson CMT, Urschel S. Health-related quality of life after pediatric heart transplantation in early childhood. Pediatr Transplant 2020; 24:e13822. [PMID: 32871049 DOI: 10.1111/petr.13822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is limited information about HRQL after pediatric heart transplantation at a young age. METHODS Prospective follow-up study of children who received a heart transplant at age ≤4 years. HRQL was assessed using the PedsQLTM 4.0 at age 4.5 years. This cohort was compared with healthy children, children with CHD, and with chronic conditions. Peri-operative factors associated with HRQL were also explored. RESULTS Of 66 eligible patients, 15 (23%) died prior to the HRQL assessment and 2 (3%) were lost to follow-up, leaving 49 patients. Indication for transplantation was CHD in 27 (55%) and CMP in 22 (45%). Median age (IQR) at transplant was 9 (5-31) months. HRQL was significantly lower in transplanted children compared to population norms (65.3 vs 87.3, P < .0001), children with chronic conditions (65.3 vs 76.1, P = .001), and children with CHD (65.3 vs 81.1, P < .0001). Transplanted children with CHD had lower HRQL than those with a prior diagnosis of CMP (59.5 vs 72.5, P-value = .020). Higher creatinine pretransplant and higher lactate post-operatively were associated with lower HRQL. CONCLUSION Children after heart transplant had significantly lower HRQL, as reported by their parents, than the normative population, children with chronic conditions, and children with CHD.
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Affiliation(s)
- Gonzalo Garcia Guerra
- Department of Pediatrics, Division of Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada
| | - Gwen Y Bond
- Department of Pediatrics, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada
| | - Ari R Joffe
- Department of Pediatrics, Division of Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada
| | - Irina A Dinu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | | | - Charlene M T Robertson
- Department of Pediatrics, Division of Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada
| | - Simon Urschel
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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4
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Evers PD, Villa C, Wittekind SG, Hobing R, Morales DLS, Lorts A. Cost-utility of continuous-flow ventricular assist devices as bridge to transplant in pediatrics. Pediatr Transplant 2019; 23:e13576. [PMID: 31535775 DOI: 10.1111/petr.13576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/02/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The initial costs of a CF-VAD exceed those of a PF-VAD. However, the safety profile of CF-VAD is superior and the possibility of outpatient device support may justify the additional initial costs. This study analyzed the cost-utility of CF-VAD use in the pediatric population. METHODS A Markov-state transition model was constructed for the clinical course of the two VAD subtypes from implantation until death with variables extracted from internal financial records and the published literature. The modeled population consisted of pediatric heart failure patients who met indications for VAD implant (INTERMACS profile 1 or 2) and were size-eligible for either a PF-VAD or CF-VAD. RESULTS The cost-utility analysis illustrated that CF-VAD is both more effective and less costly compared to PF-VAD at base-case conditions. Sensitivity analyses demonstrated that only in extreme conditions did a CF-VAD strategy not meet criteria for cost-effectiveness (if readmission rate >20% weekly, neurologic event rate >8% weekly, or CF-VAD discharge rates <18% in a month) or VAD support duration shortens to ≤12 weeks. CONCLUSION While the implantation costs of a CF-VAD exceed those of a PF-VAD, after 12 weeks of device support CF-VAD becomes the more cost-effective strategy if the anticipated outpatient device care is sufficiently long. The cost efficacy of the CF-VAD will be further heightened as initiatives that result in earlier and safer discharges, as well as reductions in readmission rates continue to be successful.
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Affiliation(s)
- Patrick D Evers
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chet Villa
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Samuel G Wittekind
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rebecca Hobing
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David L S Morales
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Angela Lorts
- Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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5
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Redondo A, Davies B, Jones R, O’Callaghan M, Kostolny M. Durable mechanical circulatory support in paediatric heart failure: The experience at Great Ormond Street Hospital. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Huang JY, Ignjatovic V, Sheridan BJ, Mathew J, D'Udekem Y, Brink J, Barton R, Callea G, Morsman D, Donath S, Opat S, Monagle P. Bleeding and thrombotic events occur early in children on durable ventricular assist devices. Thromb Res 2019; 173:65-70. [DOI: 10.1016/j.thromres.2018.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 11/26/2022]
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7
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di Bari S, Tunuguntla H, Elias B, Elhoff J. The pediatric experience of living with a ventricular assist device. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Nassar MS, Hasan A, Chila T, Schueler S, Pergolizzi C, Reinhardt Z, Lord S, De Rita F, Ferguson L, Smith J, Haynes S, O'Sullivan J, Murtuza B. Comparison of paracorporeal and continuous flow ventricular assist devices in children: preliminary results. Eur J Cardiothorac Surg 2017; 51:709-714. [PMID: 28329112 DOI: 10.1093/ejcts/ezx006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/11/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives With the scarcity of organs, a durable, reliable ventricular assist device (VAD) is required. The Berlin Heart EXCOR ® (BH) remains the most established VAD in the paediatric population. Implantable continuous flow (CF) VADs have been introduced to the paediatric field with encouraging early results. In this study, we compared the results of a newly introduced CF VAD (HeartWare VAD [HVAD] ® ) to results in a matched group of BH recipients. Methods The study included patients aged <16 years who received mechanical left VAD (LVAD) support between December 2005 and January 2016. The preimplant characteristics and postimplant outcomes of patients who received the HVAD were compared with those of a matched group who received the BH. Patients with congenital heart disease were excluded. Results Thirty patients were included in the study: 13 had received the HVAD and were matched with 17 patients who had received the BH LVAD. The only difference in preimplant characteristics was the need for higher inotropic support in the BH group. There was no difference in the need for right ventricular (RV) support (58.8% for BH vs 53.8% for HVAD, P = 1.00) or in the incidence of cerebrovascular accidents (12.5% vs 7.7%, respectively, P = 1.00), though the BH group showed prolonged mechanical ventilation (31.3% vs 0%, P = 0.047). There were no deaths while on VAD support in either group. Patients with the HVAD showed a bimodal distribution for the primary end point (transplant/explant): All HVAD recipients who also required early RV support reached this end point within 30 days of receiving the implant. Conclusions Our early experience with the CF intracorporeal LVAD system (HVAD) indicates outcomes comparable to those with the well-established pulsatile flow paracorporeal LVAD (BH). The theoretical durability of the CF device, which might also allow for the possibility of hospital discharge and better quality of life, is yet to be proven.
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Affiliation(s)
- Mohamed S Nassar
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.,Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.,Department of Cardiothoracic Surgery, Alexandria University, Alexandria, Egypt
| | - Asif Hasan
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.,Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Teresa Chila
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Stephan Schueler
- Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Carola Pergolizzi
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Zdenka Reinhardt
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.,Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Stephen Lord
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Fabrizio De Rita
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.,Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Lee Ferguson
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jon Smith
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Simon Haynes
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK
| | - John O'Sullivan
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Bari Murtuza
- Department of Paediatric Cardiac Surgery, Anaesthesia & Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK.,Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
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9
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Rai V, Gładki M, Dudyńska M, Jery J, Mroczek T, Kołcz J, Skalski J. Pneumatic paracorporeal ventricular assist device as bridge to transplant in children ≤ 20 kg: Krakow experience. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Association Between Hematologic and Inflammatory Markers and 31 Thrombotic and Hemorrhagic Events in Berlin Heart Excor Patients. Pediatr Cardiol 2017; 38:770-777. [PMID: 28184979 DOI: 10.1007/s00246-017-1578-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
Bleeding and thrombotic events remain a significant cause of morbidity in pediatric patients supported with ventricular assist devices (VADs). The objective of this study is to identify the association between markers of anticoagulation and bleeding and thrombosis events during Berlin Heart ExCor support. A retrospective, single-center analysis of 9 patients supported with the Berlin Heart ExCor was performed. Inflammatory and anticoagulation parameters including C-reactive protein, fibrinogen, partial thromboplastin time (PTT), and platelet count were measured at 48 and 24 h before and after bleeding or thrombosis events. Patients served as their own controls, and the same parameters were measured during a control period where subjects did not experience either event. All patients received the anticoagulation regimen proposed by Berlin Heart. A total of 31 bleeding or thrombotic events were identified and matched to 18 control events. Patient with predominantly thrombotic events tended to weigh less than those with bleeding events (Δ7.7 kg, p < 0.001). PTT levels were higher before and after bleeding (Δ17.36, p = 0.002) and thrombosis (Δ8.75, p < 0.001) events relative to control. Heparin dose decreased after a thrombosis event (Δ-5.67, p = 0.097), and this decrease was significantly different from control (p = 0.032). Non-collinearity between heparin dose and PTT should prompt further inflammatory and hematological investigation. In addition, heavier patients were more prone to bleeding complications. The role of inflammation in the development of thrombus or hemorrhages in the pediatric VAD population needs to be studied further.
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Abstract
The field of pediatric mechanical circulatory support has undergone a significant evolution with the advent of devices designed for children and the implementation of new strategies for deployment. With the ongoing shortage of organs the demand for new devices specifically designed for children will only increase. This review discusses the evolution of mechanical circulatory support, available devices, and the implementation of new strategies for their deployment.
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Affiliation(s)
- Iki Adachi
- Baylor College of Medicine, Houston, TX. 6621, Fannin st. Houston, Tx, 77030, USA.
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12
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Abstract
Improvements in the care of children with cardiomyopathy, CHDs, and acquired heart disease have led to an increased number of children surviving with advanced heart failure. In addition, the advent of more durable mechanical circulatory support options in children has changed the outcome for many patients who otherwise would have succumbed while waiting for heart transplantation. As a result, more children with end-stage heart failure are being referred for heart transplantation, and there is increased demand for a limited donor organ supply. A review of important publications in the recent years related to paediatric heart failure, transplantation, and mechanical circulatory support show a trend towards pushing the limits of the current therapies to address the needs of this growing population. There have been a number of publications focussing on previously published risk factors perceived as barriers to successful heart transplantation, including elevated pulmonary vascular resistance, medication non-adherence, re-transplantation, transplantation of the failed Fontan patient, and transplantation in an infant or child bridged with mechanical circulatory support. This review will highlight some of these key articles from the last 3 years and describe recent advances in the understanding, diagnosis, and management of children with end-stage heart disease.
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13
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Shi WY, Marasco SF, Saxena P, d'Udekem Y, Yong MS, Mitnovetski S, Brizard CP, McGiffin DC, Weintraub RG, Konstantinov IE. Outcomes of ventricular assist device implantation in children and young adults: the Melbourne experience. ANZ J Surg 2015; 86:996-1001. [DOI: 10.1111/ans.13368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- William Y. Shi
- Departments of Cardiology and Cardiac Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Children's Research Institute; University of Melbourne; Melbourne Victoria Australia
| | - Silvana F. Marasco
- Department of Cardiothoracic Surgery; The Alfred Hospital; Melbourne Victoria Australia
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery; The Alfred Hospital; Melbourne Victoria Australia
| | - Yves d'Udekem
- Departments of Cardiology and Cardiac Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Children's Research Institute; University of Melbourne; Melbourne Victoria Australia
| | - Matthew S. Yong
- Departments of Cardiology and Cardiac Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- Department of Cardiothoracic Surgery; The Alfred Hospital; Melbourne Victoria Australia
| | - Sergei Mitnovetski
- Departments of Cardiology and Cardiac Surgery; Royal Children's Hospital; Melbourne Victoria Australia
| | - Christian P. Brizard
- Departments of Cardiology and Cardiac Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Children's Research Institute; University of Melbourne; Melbourne Victoria Australia
| | - David C. McGiffin
- Department of Cardiothoracic Surgery; The Alfred Hospital; Melbourne Victoria Australia
| | - Robert G. Weintraub
- Departments of Cardiology and Cardiac Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Children's Research Institute; University of Melbourne; Melbourne Victoria Australia
| | - Igor E. Konstantinov
- Departments of Cardiology and Cardiac Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Children's Research Institute; University of Melbourne; Melbourne Victoria Australia
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14
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Miller JR, Eghtesady P. Ventricular assist device use in congenital heart disease with a comparison to heart transplant. J Comp Eff Res 2015; 3:533-46. [PMID: 25350804 DOI: 10.2217/cer.14.42] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Despite advances in medical and surgical therapies, some children with congenital heart disease (CHD) are not able to be adequately treated or palliated, leading them to develop progressive heart failure. As these patients progress to end-stage heart failure they pose a unique set of challenges. Heart transplant remains the standard of care; the donor pool, however, remains limited. Following the experience from the adult realm, the pediatric ventricular assist device (VAD) has emerged as a valid treatment option as a bridge to transplant. Due to the infrequent necessity and the uniqueness of each case, the pediatric VAD in the CHD population remains a topic with limited information. Given the experience in the adult realm, we were tasked with reviewing pediatric VADs and their use in patients with CHD and comparing this therapy to heart transplantation when possible.
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Affiliation(s)
- Jacob R Miller
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO 63110, USA
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15
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Miller JR, Boston US, Epstein DJ, Henn MC, Lawrance CP, Kallenbach J, Simpson KE, Canter CE, Eghtesady P. Pediatric Quality of Life while Supported with a Ventricular Assist Device. CONGENIT HEART DIS 2015; 10:E189-96. [PMID: 25864509 DOI: 10.1111/chd.12260] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Ventricular assist devices (VADs) have emerged as an important treatment option for bridging pediatric patients with heart failure to transplant. VADs have shown improved survival; however, the pediatric quality of life (QoL) while on VAD support is unknown. We aimed to evaluate the QoL of our pediatric patients while supported with a VAD. DESIGN In this prospective study, pediatric patients who underwent VAD placement, and their parents, were administered a generic Pediatric Quality of Life Inventory (PedsQL) 4.0 pre-VAD implant, when feasible, after the acute postoperative period, and then periodically until heart transplant or death. Their final scores while on support were compared with three previously reported groups: healthy controls, outpatients with severe heart disease, and children after heart transplant. RESULTS From January 2008 to July 2014, 13 pediatric patients required VAD support greater than 2 weeks and completed a PedsQL. The mean age at implant was 10.0 ± 4.2 years and median duration of support was 1.6 (0.5-19.7) months. Eleven (85%) patients survived to transplant with one (8%) patient remaining alive on support. The median duration of support prior to their final PedsQL was 1.4 (0.5-11.4) months. Patients self-reported significantly (P < .05) lower total and physical QoL scores when compared with all three comparison groups. Self-reported psychosocial QoL scores were significantly lower than healthy controls only. Parent proxy-reported scores were significantly lower than all three comparison groups for all three categories (P < .05). CONCLUSIONS A large deficit exists in the total QoL of pediatric patients supported by a VAD compared with outpatient management of severe heart disease or postheart transplant patients; however, VAD patients do represent a group with more severe heart failure. Improvements in QoL must be made, as time spent with a VAD will likely continue to increase.
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Affiliation(s)
- Jacob R Miller
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo, USA
| | - Umar S Boston
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo, USA
| | - Deirdre J Epstein
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo, USA
| | - Matthew C Henn
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo, USA
| | - Christopher P Lawrance
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo, USA
| | - Jacob Kallenbach
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo, USA
| | - Kathleen E Simpson
- Section of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Mo, USA
| | - Charles E Canter
- Section of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Mo, USA
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo, USA
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16
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Miller JR, Lancaster TS, Eghtesady P. Current approaches to device implantation in pediatric and congenital heart disease patients. Expert Rev Cardiovasc Ther 2015; 13:417-27. [PMID: 25732410 PMCID: PMC4813307 DOI: 10.1586/14779072.2015.1021786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The pediatric ventricular assist device (VAD) has recently shown substantial improvements in survival as a bridge to heart transplant for patients with end-stage heart failure. Since that time, its use has become much more frequent. With increasing utilization, additional questions have arisen including patient selection, timing of VAD implantation and device selection. These challenges are amplified by the uniqueness of each patient, the recent abundance of literature surrounding VAD use as well as the technological advancements in the devices themselves. Ideal strategies for device placement must be sought, for not only improved patient care, but also for optimal resource utilization. Here, we review the most relevant literature to highlight some of the challenges facing the heart failure specialist, and any physician, who will care for a child with a VAD.
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Affiliation(s)
- Jacob R Miller
- Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Timothy S Lancaster
- Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Pirooz Eghtesady
- Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
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17
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Khan MS, Zafar F, Morales DL. High risk congenital heart surgery and mechanical circulatory support as an alternative to heart transplantation in patients with end-stage adult congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2014. [DOI: 10.1016/j.ppedcard.2014.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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