ISHLT consensus statement for the selection and management of pediatric and congenital heart disease patients on ventricular assist devices Endorsed by the American Heart Association

Lorts, Angela; Conway, Jennifer; Schweiger, Martin; Adachi, Iki; Amdani, Shahnawaz; Auerbach, Scott R.; Barr, Charlotte; Bleiweis, Mark S.; Blume, Elizabeth D.; Burstein, Danielle S.; Cedars, Ari; Chen, Sharon; Cousino-Hood, Melissa K.; Daly, Kevin P.; Danziger‐Isakov, Lara; Dubyk, N.; Eastaugh, Lucas; Friedland‐Little, Joshua M.; Gajarski, Robert J.; Hasan, Asif; Hawkins, Beth; Jeewa, Aamir; Kindel, Steven J.; Kogaki, Shigetoyo; Lantz, J.; Law, Sabrina; Maeda, Keisuke; Mathew, Jacob; May, Lindsay J.; Miera, Oliver; Murray, Jenna; Niebler, Robert A.; O’Connor, Matthew J.; Özbaran, Mustafa; Peng, David M.; Philip, Joseph; Reardon, L.; Rosenthal, David N.; Rossano, Joseph W.; Salazar, Leonardo; Schumacher, K.; Simpson, Kathleen E.; Stiller, Brigitte; Sutcliffe, D.; Tunuguntla, Hari; VanderPluym, Christina; Villa, Chet; Wearden, Peter D.; Zafar, Farhan; Zimpfer, Daniel; Zinn, Matthew D.; Morales, Independent Reviewers: David; Cowger, Jennifer; Buchholz, Holger; Amodeo, Antonio

doi:10.1016/j.healun.2021.04.015

Cited by 53 publications

(51 citation statements)

References 259 publications

(428 reference statements)

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“…7 In children, VADs have also been increasingly used as a bridge to transplantation, with up to one-third of them being supported by VADs, as detailed in the 2019 registry report from the International Society for Heart and Lung Transplantation (ISHLT). 8 Although the causes of HF leading to the need for MCS are different between adults and children, a comorbidity commonly shared by patients with HF across the age spectrum is malnutrition. Malnutrition is prevalent in adults with chronic HF, and is an independent risk factor of mortality.…”

Section: Introductionmentioning

confidence: 99%

Nutritional outcomes of patients with pediatric and congenital heart disease requiring ventricular assist devices

Horsley

Pathak

Morales

et al. 2022

J Parenter Enteral Nutr

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Background Ventricular assist devices (VADs) support children with heart failure. The objective is to report on the nutrition outcomes of children requiring VAD. Methods This was a retrospective study performed in a tertiary care center. All patients undergoing VAD placement from 2010 to 2018 were included. Exclusion criteria were VAD placement in outside hospitals, missing baseline anthropometrics, and death in the first 15 days post‐VAD. Clinical, demographic, and nutrition data were collected from baseline and at 2 months post‐VAD. Descriptive statistics were used. Results Of the 52 patients who had undergone VAD placement, 49 (65% male, 80% with cardiomyopathy; median age at VAD, 8 years) met the study criteria. The median length of stay following VAD was 63 days. Eight patients (16%) had malnutrition at baseline (five mild, two moderate, and one severe). At 2 months post‐VAD, seven (of 49) patients had undergone heart transplantation and three (6%) were deceased. The proportion of patients with malnutrition was significantly different at 2 months post‐VAD (P = 0.009), with six patients showing evidence of malnutrition (three mild, two moderate, and one severe; body mass index z score at baseline vs 2 months: 0.11 (± 1.72) vs 0.43 (± 0.94), P = 0.049). The percent of required energy consumed increased from 77% at baseline to 90% at 2 months post‐VAD (P = 0.021). The proportion of patients fed solely enterally also increased (62% vs 84%, respectively; P = 0.042). Conclusion VADs are associated with improved nutrition outcomes. Future studies should investigate the impact of VADs on body composition and longer‐term outcomes.

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Section: Introductionmentioning

confidence: 99%

Nutritional outcomes of patients with pediatric and congenital heart disease requiring ventricular assist devices

Horsley

Pathak

Morales

et al. 2022

J Parenter Enteral Nutr

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“…Survival of patients weighing <5 kg with functionally univentricular physiology supported with VAD is novel. 6 , 7 , 8 , 9 , 10 , 11 In 2008, Pearce and colleagues 6 reported successful cardiac transplantation after Berlin Heart insertion and bridging in a 15-month-old boy with a functionally univentricular heart (double-outlet right ventricle [S,D,D], mitral valve atresia, D-malposition of the great vessels, status post-pulmonary artery band in infancy) and poor systemic ventricular function, using an aortopulmonary shunt as a supplementary source of pulmonary blood flow. In 2014, Weinstein and colleagues 7 reported a retrospective review of the EXCOR Investigational Device Exemption study database that included VAD implants under the primary cohort and the compassionate use cohort between May 2007 and December 2011.…”

Section: Discussionmentioning

confidence: 99%

“…Also in 2021, the International Society for Heart and Lung Transplantation published a consensus statement for the selection and management of patients with pediatric and congenital heart disease on a VAD. 11 This consensus statement was endorsed by the American Heart Association and provides the following key points regarding support strategies for functionally univentricular patients on a VAD 11 : To support Stage 1 patients with parallel circulations, VAD flows to achieve a higher cardiac index are often required, and a balanced Qp/Qs is crucial. In Stage 2 patients, converting to shunted or Fontan physiology at the time of VAD implantation may be considered for improved pulmonary blood flow.…”

Section: Discussionmentioning

confidence: 99%

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Ventricular assist device support in neonates and infants with a failing functionally univentricular circulation

et al. 2022

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“…Our group, among others, has highlighted “the reality of limping to pediatric heart transplantation.” 3 We have advocated for early VAD implantation and consideration for transplantation in challenging patients rather than continuing to pursue palliative univentricular procedures and waiting until patients are too sick to have good waitlist or post-transplant outcomes. 3 , 4 However, the authors do believe that patients with hypoplastic left heart syndrome who present in shock with organ insufficiency but preserved function can be palliated with bilateral pulmonary arterial banding and resuscitated to a point in which they can usually undergo a successful Norwood.…”

mentioning

confidence: 99%

Commentary: When to go “all in”

Greenberg

Morales

2022

JTCVS Techniques

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Cardiac surgery is a specialty of "big" decisions. Bleiweis and colleagues 1 report their algorithms for the surgical management of neonates and infants with failing univentricular congenital heart disease, their surgical technique for "hybrid" palliation with ventricular assist device (VAD) implantation, and results from their institutional experience thereof.The algorithm and surgical techniques highlightedwhile comprehensive and an interesting contribution to the literature-are not wholly novel, nor is the concept of bridging to transplant with VAD complex univentricular patients. The real contribution for which the authors should be applauded is their discussion of early commitment to VAD implantation and listing for transplant in the most challenging, high-risk patients. These are the patients with whom we are all familiar and recognize to be high-risk for single-ventricle palliations: the patient with hypoplastic left heart syndrome and severe tricuspid regurgitation, those with ventricular dysfunction from birth, and those with large coronary fistulae with signs of ischemia.Instead of first attempting high-risk palliation with the plan of "bailing out" to VAD and transplantation if this fails, the authors commit directly to VAD/transplantation. This strategy prevents intervening surgeries that may result in possible extracorporeal membrane oxygenation runs and/

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ISHLT consensus statement for the selection and management of pediatric and congenital heart disease patients on ventricular assist devices Endorsed by the American Heart Association

Cited by 53 publications

References 259 publications

Nutritional outcomes of patients with pediatric and congenital heart disease requiring ventricular assist devices

Nutritional outcomes of patients with pediatric and congenital heart disease requiring ventricular assist devices

Ventricular assist device support in neonates and infants with a failing functionally univentricular circulation

Commentary: When to go “all in”

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