Ventricular Assist Devices Succeed as Bridge to Transplant, Even for Infants

Published August 2018 | The Annals of Thoracic Surgery

Ventricular assist devices (VADs) are saving lives for children with heart failure as they wait for organ transplants—and despite being sicker and weaker at the time of transplant, survival times rival those who did not need an assist device.

“Because of challenges in the past in trying to support our smallest and most ill infants, there has been a recent change in support strategy that has been improving outcomes significantly,” says senior author David Morales, MD.

Infants with congenital heart disease (CHD) are a high-risk population for heart transplantation. Overall, CHD accounts for 55% of all infant heart transplants of whom more than 11% reach transplant on VAD support, according to the International Society of Heart Lung Transplantation Registry Report.

Morales and his team set out to compare outcomes of patients who used VADs versus those who did not. CHD patients with VAD spent longer on transplant waiting lists than those without VAD. They also were more ill at the time of transplant, with worse heart function and higher infection levels. Despite this, post-transplant survival was similar between the groups.

These results have “encouraged the use of VADs in patients with CHD. These devices can support children who in the past we could not,” Morales says. “However, this remains a very challenging cohort.”

Data from this study will support developing improved clinical guidelines for using VADs as a bridge to transplant in young CHD patients.