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Eighteen years of paediatric extracorporeal membrane oxygenation and ventricular assist devices: insight regarding late outcomes

  • Shawn M. Shah (a1), David W. Kays (a2), Sharon R. Ghazarian (a3), Tom R. Karl (a1) (a4), Plato Alexander (a1), Nathaniel Sznycer-Taub (a1), Jason Parker (a1), Molly Oldeen (a1), Melvin C. Almodovar (a1), Gary Stapleton (a1), James A. Quintessenza (a1) (a2) (a3) (a4), Alfred Asante-Korang (a1), Vyas Kartha (a1), Jade Hanson (a1), Ernest Amankwah (a3), Joeli Roth (a1) and Jeffrey P. Jacobs (a1) (a4)...

Abstract

Background

We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.

Methods

A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan–Meier method.

Results

A total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan–Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan–Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%.

Conclusions

This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan–Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.

Copyright

Corresponding author

Author for correspondence: J. P. Jacobs, MD, FACS, FACC, FCCP Professor of Surgery and Pediatrics, Johns Hopkins University, Deputy Director, Johns Hopkins All Children’s Heart Institute, Chief, Division of Cardiovascular Surgery, Director, Andrews/Daicoff Cardiovascular Program, and Surgical Director of Heart Transplantation, Johns Hopkins All Children’s Hospital, 601 Fifth Street South, Suite 607, Saint Petersburg, FL 33701, USA. Tel: +727 235 3100; Fax: +727 767 3704; E-mail: JeffJacobs@jhmi.edu; JeffJacobs@msn.com

References

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4. Mascio, CE, Austin, EH 3rd, Jacobs, JP, Jacobs, ML, Wallace, AS, He, X, Pasquali, SK. Perioperative mechanical circulatory support in children: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2014; 147: 658665.
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6. David, LS, Morales, MD, Farhan Zafar, MD, et al. Use of ventricular assist devices in children across the United States: analysis of 7.5 million pediatric hospitalizations. Ann Thorac Surg 2010; 90: 13131318; discussion 1318–1319.
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11. Jacobs, JP. Introduction to the 2015 Supplement to Cardiology in the Young: Proceedings of the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute. Cardiol Young 2015; 25 (Suppl 2): 17.
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14. Steele, A, Boucek, RJ Jr, Jacobs, JP, et al. Heart cells with regenerative potential from pediatric patients with end stage heart failure: a translatable method to enrich and propagate. Stem Cells Int 2012; 2012: 452102.
15. Boucek, RJ Jr, Steele, J, Jacobs, JP, et al. Ex vivo paracrine properties of cardiac tissue: effects of chronic heart failure. J Heart Lung Transplant 2015; 34: 839848.

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