Evolution and impact of ventricular assist device program on children awaiting heart transplantation.

Autor:	Adachi I; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas. Electronic address: iadachi@bcm.edu., Khan MS; The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Guzmán-Pruneda FA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas., Fraser CD 3rd; University of Texas at Houston School of Medicine, Houston, Texas., Mery CM; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas., Denfield SW; Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas., Dreyer WJ; Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas., Morales DL; The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., McKenzie ED; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas., Heinle JS; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas., Fraser CD Jr; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2015 Feb; Vol. 99 (2), pp. 635-40. Date of Electronic Publication: 2014 Dec 19.
DOI:	10.1016/j.athoracsur.2014.10.010
Abstrakt:	Background: We sought to evaluate the impact of the evolution of a pediatric mechanical circulatory support (MCS) program on outcomes of children listed for heart transplantation at our institution. Methods: All patients listed for isolated heart transplantation from 1995 to 2013 were included. The use of MCS while on the wait-list was recorded. Wait-list and posttransplant outcomes were compared before and after 2005, which was when we became capable of providing long-term MCS without size limitation. Results: In total, 259 patients were listed for transplant and 201 (78%) reached transplant. The use of MCS was significantly increased between the eras (13% and 37%, p = 0.0001). Wait-list mortality was significantly decreased (25% and 11%, p = 0.0006). Among transplant recipients, the proportion of patients who underwent MCS was significantly increased (13% and 37%, p = 0.0002). Of these MCS patients, the use of long-term devices was significantly increased (50% and 98%, p = 0.0004). Median duration of MCS was significantly increased (12 and 78 days, p = 0.004). Kaplan-Meier estimates showed a trend (p = 0.08) toward improved survival after bridge-to-transplant both at 1 year (70% in the early era and 88% in the late era) and at 5 years (60% and 78%, respectively). Conclusions: Outcomes of pediatric heart transplantation have significantly improved over the last 2 decades. We believe such improvement is, at least in part, attributable to maturation of MCS strategy, characterized by avoiding the use of temporary devices such as extracorporeal membrane oxygenation as a bridge-to-transplant and a more aggressive use of long-term devices. (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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