We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Durable left ventricular assist device explantation following recovery in paediatric patients: Determinants and outcome after explantation.
- Authors
Rohde, Sofie; Miera, Oliver; Sliwka, Joanna; Sandica, Eugen; Amodeo, Antonio; Veen, Kevin; By, Theo M M H de; Bogers, Ad J J C; Schweiger, Martin
- Abstract
Open in new tab Download slide OBJECTIVES Myocardial recovery in children supported by a durable left ventricular assist device is a rare, but highly desirable outcome because it could potentially eliminate the need for a cardiac transplant and the lifelong need for immunosuppressant therapy and the risk of complications. However, experience with this specific outcome is extremely limited. METHODS All patients < 19 years old supported by a durable left ventricular assist device from the European Registry for Patients with Mechanical Circulatory Support database were included. Participating centres were approached for additional follow-up data after explantation. Associated factors for explantation due to myocardial recovery were explored using Cox proportional hazard models. RESULTS The incidence of recovery in children supported by a durable left ventricular assist device was 11.7% (52/445; median duration of support, 122.0 days). Multivariable analyses showed body surface area (hazard ratio 0.229; confidence interval 0.093–0.565; P = 0.001) and a primary diagnosis of myocarditis (hazard ratio 4.597; confidence interval 2.545–8.303; P < 0.001) to be associated with recovery. Left ventricular end-diastolic diameter in children with myocarditis was not associated with recovery. Follow-up after recovery was obtained for 46 patients (88.5%). Sustained myocardial recovery was reported in 33/46 (71.7%) at the end of the follow-up period (28/33; >2 year). Transplants were performed in 6/46 (11.4%) (in 5 after a ventricular assist device was reimplanted). Death occurred in 7/46 (15.2%). CONCLUSIONS Myocardial recovery occurs in a substantial portion of paediatric patients supported with durable left ventricular assist devices, and sustainable recovery is seen in around three-quarters of them. Even children with severely dilated ventricles due to myocarditis can show recovery. Clinicians should be attentive to (developing) myocardial recovery. These results can be used to develop internationally approved paediatric weaning guidelines.
- Subjects
HEART assist devices; CHILD patients; ARTIFICIAL blood circulation; PROPORTIONAL hazards models; BODY surface area; HEART transplantation
- Publication
European Journal of Cardio-Thoracic Surgery, 2024, Vol 65, Issue 4, p1
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezae126