Ventricular assist device implantation in children with a mechanical valve: An ACTION registry analysis

Ventricular assist device implantation in children with a mechanical valve: An ACTION registry analysis

Background: Patients with congenital heart disease (CHD) frequently have had valve interventions, including replacement with a mechanical valve (mechV). The impact of a mechV on clinical outcomes in patients undergoing ventricular assist device (VAD) implantation is not well characterized. Objective...

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Main Authors: Sabena F. Hussain, MD, MSc, Elyse Miller, MD, Othman Aljohani, MBBS, MPH, Scott Auerbach, MD, David Bearl, MD, Victor Benvenuto, MD, Erica Bonura, MD, Richard L. Crawford, Anna Joong, MD, Jameson Dyal, MD, Christina Hartje-Dunn, MD, Sujit Jana, MD, Sonia Kaushal, MD, Melanie Lynn, MD, Joseph Spinner, MD, Laura Radel, MD, Alexander Raskin, MD, Diana Torpoco-Rivera, MD, Sarah J. Wilkens, MD, MPH, Chet R. Villa, MD
Format: Article
Language:English
Published: Elsevier 2025-02-01
Series:JHLT Open
Subjects:
ACTION learning network
pediatrics
ventricular assist device
mechanical valve
congenital heart disease
Online Access:http://www.sciencedirect.com/science/article/pii/S2950133424001484
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Summary:Background: Patients with congenital heart disease (CHD) frequently have had valve interventions, including replacement with a mechanical valve (mechV). The impact of a mechV on clinical outcomes in patients undergoing ventricular assist device (VAD) implantation is not well characterized. Objectives: This study assessed VAD outcomes in patients with CHD and a mechV. Methods: All patients with a history of CHD (n = 433) in the Advanced Cardiac Therapies Improving Outcomes Network database were included in the study (January 2012-January 2023). Patient characteristics and outcomes were assessed among patients with a mechV and without a mechV. Results: Twenty-seven (6%) patients with CHD had a mechV at VAD implantation. Fourteen (52%) of the patients with mechV had univentricular anatomy and 13 (48%) had biventricular anatomy. Patients with mechV were older (4.9 vs 1.9 years, p = 0.02), smaller (14.9 vs 10.6 kg, p = 0.02), and had a higher interagency registry for mechanically assisted circulatory support profile (p = 0.01). Three (11%) patients with mechV experienced a valve-related complication. There was no difference in survival (p = 0.4) or ischemic stroke frequency (11% vs 13%, p = 1) between patients with mechV and non-mechV. Patients with mechV had higher frequency of hemorrhagic stroke (18% vs 4.7%, p = 0.01) and major bleeding (44% vs 26%, p = 0.04). Conclusions: Patients with CHD with a mechV have similar survival to patients with non-mechV; however, there is higher risk of bleeding including hemorrhagic stroke.
ISSN:2950-1334

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