Australian Experience with VAD as a Bridge to Paediatric Cardiac Transplantation

Paediatric heart transplantation in Australia comes of age: 21 years of experience in a national centre

“…While other studies have reported increased mortality for patients receiving mechanical support or ventilation, urgency of listing and those with CHD, in our population age at time of listing, <10 years was the only parameter associated with increased risk of death. In the future, our high waiting list mortality may be impacted by measures, such as improved targeted therapy for heart failure management in children, use of palliative procedures for CHD, increasing donor organ availability, as well as improved mechanical support of those patients waiting …”

“…In the future, our high waiting list mortality may be impacted by measures, such as improved targeted therapy for heart failure management in children, use of palliative procedures for CHD, increasing donor organ availability, as well as improved mechanical support of those patients waiting. 8,32 Infants generally have worse wait-list outcomes than the overall paediatric population, with mortality between 27% and 31% in patients less than 12 months old reported in single-centre studies, 30,33,34 and an equivalent multi-centre review of the SRTR demonstrating 23% of waiting infants died within 6 months of listing. 35 Indeed, while overall mortality on HT waiting list has improved for children over time, this effect has not been observed in infants.…”

Outcome of pediatric heart transplantation recipients treated with ventricular assist device

“…The reported incidence of neurological complications during VAD support varies between 10% and 60% . The most probable cause of the neurological complications is related to cannulation protocol or anticoagulation .…”

Outcomes of ventricular assist device implantation in children and young adults: the Melbourne experience

“…In adults, ventricular assist devices (VAD) have been widely used as a bridge to transplantation . Applying VAD technology to younger patients, however, has been challenging . Children bridged to heart transplantation with VADs are increasingly younger and smaller .…”

“…1 Applying VAD technology to younger patients, however, has been challenging. [2][3][4] Children bridged to heart transplantation with VADs are increasingly younger and smaller. 5 Although the outcomes of heart transplantation in children bridged with VAD are comparable with unsupported patients, 5,6 children less than 10 kg still have higher complication rates.…”