Ventricular assist devices (VADs) are being increasingly used to support children with end stage heart failure (HF) as a bridge to transplant or decision to candidacy, with a dramatic increase in the last decade The aims of this study are to review trends in admissions of pediatric patients supported with VADs at children’s hospitals in the U.S. over a ten-year period, to assess rates of major complications in these patients, and to identify risk factors for adverse outcomes Multicenter retrospective analysis of the Pediatric Hospitals Information System (PHIS) database from 2005 to 2015 Inclusion criteria: (i) Age < 21years, (ii) ICD-9 codes for VAD implantation Primary outcome: hospital mortality. Secondary outcomes: total hospital length of stay (LOS), total cost of services (RCC method) Categorical and continuous variables compared using χ2/ Fisher exact and nonparametric tests respectively Univariate and multivariable analyses performed using generalized estimating equations (GEE) for categorical outcomes and mixed modeling for continuous outcomes, to account for clustering within hospitals - factors with p<0.2 on univariate analysis included in the initial multivariable model, and factors with p<0.05 retained in successive models Use of VADs in the pediatric population is continuing to increase over time, with a stable mortality and complication rate There is an increase in patients able to be discharged home with a VAD in place Clinical features including acute renal failure, liver congestion, sepsis, cerebrovascular accident and need for ECMO support continue to complicate peri-implant VAD support, and are associated with mortality VAD repair during the VAD implant admission is associated with longer length of stay and total cost, however was not associated with mortality

1. CHARACTERISTICS AND OUTCOMES OF PEDIATRIC PATIENTS SUPPORTED
WITH VENTRICULAR ASSIST DEVICE – A MULTI-INSTITUTIONAL ANALYSIS
BACKGROUND
• Ventricular assist devices (VADs) are being increasingly used to support children with end stage heart failure (HF) as a bridge to transplant or decision to
candidacy, with a dramatic increase in the last decade
• The aims of this study are to review trends in admissions of pediatric patients supported with VADs at children’s hospitals in the U.S. over a ten-year
period, to assess rates of major complications in these patients, and to identify risk factors for adverse outcomes
1 – Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital
2 –Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital
CONCLUSIONS
1 - No significant difference in sex, race/ethnicity or underlying CHD between earlier and later eras
METHODS
• Multicenter retrospective analysis of the Pediatric Hospitals Information System (PHIS) database from 2005 to 2015
• Inclusion criteria: (i) Age < 21years, (ii) ICD-9 codes for VAD implantation
• Primary outcome: hospital mortality. Secondary outcomes: total hospital length of stay (LOS), total cost of services (RCC method)
• Categorical and continuous variables compared using χ2/ Fisher exact and nonparametric tests respectively
• Univariate and multivariable analyses performed using generalized estimating equations (GEE) for categorical outcomes and mixed modeling for
continuous outcomes, to account for clustering within hospitals - factors with p<0.2 on univariate analysis included in the initial multivariable model,
and factors with p<0.05 retained in successive models
@ - 19 patients with unknown race/ethnicity excluded, # - variables in final model listed
RESULTS
INTRODUCTION
TABLE 1. COMPARISON OF CLINICAL FEATURES AND OUTCOMES DURING VAD IMPLANT ADMISSION BY ERA1
CLINICAL FEATURES ALL 2005-2015 (n=751)
EARLY ERA 2005-2010
(n=297)
LATER ERA 2011-2015
(n=454)
p-value
Age in years, median (IQR) 5.8 (0.9 – 13.6) 4.9 (0.7 – 13.5) 6.3 (1.0 – 13.7) 0.215
Acute Renal Failure, n (%) 306 (41) 113 (38) 193 (43) 0.223
Sepsis, n (%) 249 (33) 122 (41) 127 (28) <0.001
Cerebrovascular Accidents, n (%) 229 (31) 95 (32) 134 (30) 0.472
Pulmonary Hypertension, n (%) 165 (22) 57 (19) 108 (24) 0.137
Arrhythmias, n (%) 428 (57) 153 (52) 275 (61) 0.013
CHD Surgery during Admission, n (%) 232 (65) 90 (38) 142 (53) 0.001
ECMO use, n (%) 345 (45) 136 (46) 209 (46) 0.948
Bleeding Complications, n (%) 466 (60) 192 (65) 274 (60) 0.213
Thrombotic Complications, n (%) 285 (37) 114 (39) 171 (38) 0.869
Percutaneous VAD, n (%) 11 (1) 4 (1) 7 (2) 0.828
Biventricular Support, n (%) 151 (20) 67 (23) 84 (19) 0.175
OUTCOMES
VAD replacement/repair, n (%) 181 (23) 62 (21) 119 (26) 0.095
Transplant, n (%) 400 (52) 181 (61) 219 (48) 0.001
Mortality, n (%) 192 (25) 81 (27) 111 (24) 0.386
Discharge with VAD, n (%) 141 (19) 37 (13) 104 (22) <0.001
Length of Stay in days, median (IQR) 69 (36 – 122) 69 (35 – 134) 70 (37 – 115) 0.660
Total Cost (RCC method), median (IQR) 581,956 (366,989 – 927,681) 563,224 (323,640 – 850,642) 602,689 (385,083 – 968,607) 0.010
TABLE 2. UNIVARIATE AND MULTIVARIABLE ANALYSIS FOR PRIMARY OUTCOME BY GEE METHOD
CHARACTERISTIC DEATH (N=192)
SURVIVED
(N=559)
p-value uni p-value multi# OR (95% CI)
Era, n (%) 0.254
2005 – 2010 81 (42) 216 (39)
2011 – 2015 111 (58) 343 (61)
Age, median (IQR) 2.8 (0.2 – 10.9) 6.9 (1.3 – 14.1) <0.001
Male Sex, n (%) 103 (54) 323 (58) 0.314
Race/Ethnicity, n (%)@
Non-Hispanic White 107 (56) 258 (46) reference reference
Hispanic 29 (15) 114 (20) 0.089 0.060
Non-Hispanic Black 20 (10) 119 (21) 0.004 0.025 0.53 (0.30 – 0.92)
Others 26 (14) 61 (11) 0.868 0.494
History of CHD, n (%) 96 (50) 132 (24) <0.001 <0.001 2.56 (1.78 – 3.69)
Acute Renal Failure, n (%) 117 (61) 189 (34) <0.001 <0.001 2.44 (1.68 – 3.55)
Liver Congestion or Failure, n (%) 43 (22) 67 (12) <0.001 0.044 1.51 (1.01 – 2.24)
Sepsis, n (%) 91 (47) 158 (28) <0.001 0.014 1.68 (1.11 – 2.54)
Cerebrovascular Accident, n (%) 93 (48) 136 (24) <0.001 <0.001 2.61 (1.69 – 4.03)
Pulmonary Hypertension, n (%) 36 (19) 129 (23) 0.300
Arrhythmias, n (%) 106 (55) 322 (58) 0.994
CHD Surgery during Admission, n (%) 76 (61) 156 (41) 0.002
ECMO use, n (%) 139 (72) 206 (37) <0.001 <0.001 3.39 (2.42 – 4.74)
Bleeding Complications, n (%) 142 (74) 324 (58) <0.001
Thrombotic Complications, n (%) 92 (48) 193 (35) 0.005
Percutaneous VAD, n (%) 3 (2) 8 (1) 0.763
Biventricular Support, n (%) 51 (27) 100 (18) 0.022
VAD replacement/repair, n (%) 47 (25) 134 (24) 0.968
• Use of VADs in the pediatric population is continuing to increase over time, with a stable mortality and complication rate
• There is an increase in patients able to be discharged home with a VAD in place
• Clinical features including acute renal failure, liver congestion, sepsis, cerebrovascular accident and need for ECMO support continue to complicate peri-
implant VAD support, and are associated with mortality
• VAD repair during the VAD implant admission is associated with longer length of stay and total cost, however was not associated with mortality
K Puri1, J Causey2, SC Tume2, LS Shekerdemian2, AG Cabrera1, Y Wang1, BS Moffett2, MM Anders2
• Analysis revealed 751 patients treated at 37 hospitals – 59% (454/751) during later era (2011-2015), 38% (297/751) from early era (2005 – 2010)
• Mortality for all VAD admissions - 25%; 52% of the patients were bridged to transplant during index admission
• Length of Stay - After multivariable analysis, younger age at admission (p=0.001), African American Race (p<0.001), sepsis (p<0.001), arrhythmias
(p=0.004), VAD repair (p<0.001) and thrombotic complications (p<0.001) were associated with longer length of stay
• Total Cost - After multivariable analysis, later era (p=0.003), African-American race (p=0.015), sepsis (p<0.001), renal failure (p=0.001), arrhythmias
(p<0.001), ECMO (p<0.001), VAD repair (p<0.001), bleeding complications (p<0.001) and thrombotic complications (p=0.001) was associated with
higher total cost
SECONDARY OUTCOMES