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The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: an analysis of the United Network for Organ Sharing database.
J Thorac Cardiovasc Surg. 2008 Feb; 135(2):421-7, 427.e1.JT

Abstract

OBJECTIVES

The use of mechanical circulatory support to bridge pediatric patients to cardiac transplantation presents unique challenges because of the difficult anatomy and physiology in these patients.

METHODS

The United Network for Organ Sharing provided deidentifed patient-level data. The study population included 2532 transplantations performed on patients less than 19 years old in status 1/1A/1B between 1995 and 2005. Mechanical circulatory support was used in 431 patients: 241 (9.5%) received ventricular assist devices, 171 (6.8%) underwent extracorporeal membrane oxygenation, and 19 (0.8%) received intra-aortic balloon pumps.

RESULTS

Patients supported on ventricular assist devices had similar levels of hospitalization and intensive care use and less need for inotropic support (P < .0002) than had those not needing support. Five- and 10-year posttransplantation survival was better in patients receiving ventricular assist devices and patients not receiving mechanical circulatory support than in patients receiving extracorporeal membrane oxygenation or intra-aortic balloon pumping (P < .0001). Among mechanically supported patients, patients with a body surface area of less than 0.30 (odds ratio, 1.70; 95% confidence interval, 1.18-2.43) and those requiring extracorporeal membrane oxygenation (odds ratio, 1.65; 95% confidence interval, 1.15-2.35) or intra-aortic balloon pumping (odds ratio, 1.91; 95% confidence interval, 1.02-3.56) had higher long-term mortality. The use of a ventricular assist device at transplantation did not predict higher long-term, posttransplantation mortality.

CONCLUSIONS

Pediatric patients requiring a pretransplantation ventricular assist device have long-term survival similar to that of patients not receiving mechanical circulatory support. Early survival among patients undergoing extracorporeal membrane oxygenation and infants is poor, reinforcing the need for improvements in device design and physiologic management of infants and neonates.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, Children's Hospital of New York-Presbyterian and Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18242279

Citation

Davies, Ryan R., et al. "The Use of Mechanical Circulatory Support as a Bridge to Transplantation in Pediatric Patients: an Analysis of the United Network for Organ Sharing Database." The Journal of Thoracic and Cardiovascular Surgery, vol. 135, no. 2, 2008, pp. 421-7, 427.e1.
Davies RR, Russo MJ, Hong KN, et al. The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: an analysis of the United Network for Organ Sharing database. J Thorac Cardiovasc Surg. 2008;135(2):421-7, 427.e1.
Davies, R. R., Russo, M. J., Hong, K. N., O'Byrne, M. L., Cork, D. P., Moskowitz, A. J., Gelijns, A. C., Mital, S., Mosca, R. S., & Chen, J. M. (2008). The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: an analysis of the United Network for Organ Sharing database. The Journal of Thoracic and Cardiovascular Surgery, 135(2), 421-7, e1. https://doi.org/10.1016/j.jtcvs.2007.09.048
Davies RR, et al. The Use of Mechanical Circulatory Support as a Bridge to Transplantation in Pediatric Patients: an Analysis of the United Network for Organ Sharing Database. J Thorac Cardiovasc Surg. 2008;135(2):421-7, 427.e1. PubMed PMID: 18242279.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: an analysis of the United Network for Organ Sharing database. AU - Davies,Ryan R, AU - Russo,Mark J, AU - Hong,Kimberly N, AU - O'Byrne,Michael L, AU - Cork,David P, AU - Moskowitz,Alan J, AU - Gelijns,Annetine C, AU - Mital,Seema, AU - Mosca,Ralph S, AU - Chen,Jonathan M, PY - 2007/06/29/received PY - 2007/08/30/revised PY - 2007/09/19/accepted PY - 2008/2/5/pubmed PY - 2008/3/11/medline PY - 2008/2/5/entrez SP - 421-7, 427.e1 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 135 IS - 2 N2 - OBJECTIVES: The use of mechanical circulatory support to bridge pediatric patients to cardiac transplantation presents unique challenges because of the difficult anatomy and physiology in these patients. METHODS: The United Network for Organ Sharing provided deidentifed patient-level data. The study population included 2532 transplantations performed on patients less than 19 years old in status 1/1A/1B between 1995 and 2005. Mechanical circulatory support was used in 431 patients: 241 (9.5%) received ventricular assist devices, 171 (6.8%) underwent extracorporeal membrane oxygenation, and 19 (0.8%) received intra-aortic balloon pumps. RESULTS: Patients supported on ventricular assist devices had similar levels of hospitalization and intensive care use and less need for inotropic support (P < .0002) than had those not needing support. Five- and 10-year posttransplantation survival was better in patients receiving ventricular assist devices and patients not receiving mechanical circulatory support than in patients receiving extracorporeal membrane oxygenation or intra-aortic balloon pumping (P < .0001). Among mechanically supported patients, patients with a body surface area of less than 0.30 (odds ratio, 1.70; 95% confidence interval, 1.18-2.43) and those requiring extracorporeal membrane oxygenation (odds ratio, 1.65; 95% confidence interval, 1.15-2.35) or intra-aortic balloon pumping (odds ratio, 1.91; 95% confidence interval, 1.02-3.56) had higher long-term mortality. The use of a ventricular assist device at transplantation did not predict higher long-term, posttransplantation mortality. CONCLUSIONS: Pediatric patients requiring a pretransplantation ventricular assist device have long-term survival similar to that of patients not receiving mechanical circulatory support. Early survival among patients undergoing extracorporeal membrane oxygenation and infants is poor, reinforcing the need for improvements in device design and physiologic management of infants and neonates. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/18242279/The_use_of_mechanical_circulatory_support_as_a_bridge_to_transplantation_in_pediatric_patients:_an_analysis_of_the_United_Network_for_Organ_Sharing_database_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(07)01695-9 DB - PRIME DP - Unbound Medicine ER -