United States Trends in Pediatric Ventricular Assist Implantation as Bridge to Transplantation.

Ventricular assist devices (VADs) are increasingly used to support children to heart transplant, however, it is unclear whether this trend is broadly applicable across the age/size spectrum. Children (≤18 years) listed for transplant were identified from the United Network of Organ Sharing (UNOS) database between January 2006 and May 2014. Patients were stratified by era (Early: 2006-2010, Current: 2011-2014), size (<25, 25-50, and >50 kg), and device type. Of 3,986 patients, 520 (13%) were supported by a VAD. The proportion of patients supported with a VAD has increased in the current era (16% vs. 11%, p < 0.001). The increase has occurred in children <25 kg (11% vs. 7%, p < 0.001) and >50 kg (26% vs. 17%, p < 0.002). Although VAD utilization was similar across eras in patients 25-50 kg (14% vs. 13%, p = 0.6), continuous flow VAD (cfVAD) use increased dramatically from 7% to 52% (p < 0.001). Waitlist outcome (p = 0.6) and posttransplant survival (p = 0.53) were similar between eras despite the shift to cfVADs in patients ≥25 kg. The emergence of cfVAD technology in an era of increasing waitlist times raises the prospect of an increasing population of children with cfVADs at home and in our communities.