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Comparative Study
. 2020 Nov;160(5):1301-1308.e2.
doi: 10.1016/j.jtcvs.2019.11.068. Epub 2019 Dec 9.

Utilization and outcomes in biventricular assist device support in pediatrics

Nathanya Baez Hernandez  1 , Richard Kirk  2 , David Sutcliffe  2 , Ryan Davies  3 , Robert Jaquiss  3 , Ang Gao  4 , Song Zhang  4 , Ryan J Butts  2
Affiliations
Comparative Study

Utilization and outcomes in biventricular assist device support in pediatrics

Nathanya Baez Hernandez et al. J Thorac Cardiovasc Surg. 2020 Nov.

Abstract

Objective: Patients with biventricular assist devices (BiVADs) have worse outcomes than those with left ventricular assist devices (LVADs). It is unclear whether these outcomes are due to device selection or patient factors. We used propensity score matching to reduce patient heterogeneity and compare outcomes in pediatric patients supported with BiVADs with a similar LVAD cohort.

Methods: The Pedimacs registry was queried for patients who were supported with BiVAD or LVAD. Patients were analyzed by BiVAD or LVAD at primary implant and the 2 groups were compared before and after using propensity score matching.

Results: Of 363 patients who met inclusion criteria, 63 (17%) underwent primary BiVAD support. After propensity score matching, differences between cohorts were reduced. Six months after implant, in the BiVAD cohort (LVAD cohort) 52.5% (42.5%) had been transplanted; 32.5% (40%) were alive with device, and 15% (10%) had died. Survival was similar between cohorts (P = .31, log-rank), but patients with BiVADs were more likely to experience a major adverse event in the form of bleeding (P = .04, log-rank). At 1 week and 1 and 3 months' postimplant, the percentage of patients on mechanical ventilation, on dialysis, or with elevated bilirubin was similar between the 2 groups.

Conclusions: When propensity scores were used to reduce differences in patient characteristics, there were no differences in survival but more major adverse events in the patients with BiVADs, particularly bleeding. Differences in unmatched patient outcomes between LVAD and BiVAD cohorts likely represent differences in severity of illness rather than mode of support.

Keywords: biventricular assist device; pediatrics.

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Figures

FIGURE E1.
FIGURE E1.
Survival in the unmatched cohort. Kaplan–Meier curve depicting survival after VAD implant in the unmatched cohort. Patients with LVAD are depicted by a blue line and patients with BiVAD by a red line. Patients with LVAD had better survival. Patients censored at time of transplant and/or at device explant for recovery. Shaded areas indicate 95% confidence intervals for each group. BIVAD, Biventricular assist device; LVAD, left ventricular assist device.
FIGURE 1.
FIGURE 1.
Patient cohort. Bar graph depicting the percent of VAD implants that made study inclusion/exclusion criteria that were BiVADs (red) versus LVADs (blue) by year. LVAD, Left ventricular assist device, BiVAD, biventricular assist device.
FIGURE 2.
FIGURE 2.
Survival in the matched cohort. Kaplan–Meier curve depicting survival after VAD implant for propensity score–matched patients, with patients on LVAD depicted by a blue curve and those on BiVAD by a red curve. No difference was seen in survival between cohorts. Patients censored at time of transplant and/or at device explant for recovery. Shaded areas indicate 95% confidence intervals for each group. BiVAD, Biventricular assist device; LVAD, left ventricular assist device.
FIGURE 3.
FIGURE 3.
Adverse events in the matched cohort. Kaplan–Meier curve depicting freedom from any major adverse event after VAD implant for propensity score–matched patients, with patients on LVAD depicted by a blue curve and patients on BiVAD by a red curve. Patients censored at time of transplant and/or at device explant for recovery. Shaded areas indicate 95% confidence intervals for each group. BiVAD, Biventricular assist device; LVAD, left ventricular assist device.
FIGURE 4.
FIGURE 4.
Freedom from adverse events in the matched cohort. Kaplan–Meier curve depicting freedom from each individual major adverse event after VAD implant for propensity score–matched patients, with patients on LVAD depicted by a blue curve and patients on BiVAD by a red curve. Patients censored at time of transplant and/or at device explant for recovery. Shaded areas indicate 95% confidence intervals for each group.
FIGURE 5.
FIGURE 5.
Postimplant survival before and after propensity matching. Kaplan–Meier curve depicting post-VAD implant survival before and after propensity score–matched patients, with patients on LVAD depicted by a blue curve and patients on BiVAD by a red curve. No difference was seen in survival between cohorts after propensity matching. Patients censored at time of transplant and/or at device explant for recovery. Shaded areas indicate 95% confidence intervals for each group. BiVAD, Biventricular assist device; LVAD, left ventricular assist device.
VIDEO 1.
VIDEO 1.
Ventricular assist device in the pediatric population. Video available at: https://www.jtcvs.org/article/S0022-5223(19)36113-6/fulltext.
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References

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