Outcomes following implantation of mechanical circulatory support in adults with congenital heart disease: An analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)

Christina J. VanderPluym, Ari Cedars, Pirooz Eghtesady, Bryan G. Maxwell, Jill M. Gelow, Luke J. Burchill, Simon Maltais, Devin A. Koehl, Ryan S. Cantor, Elizabeth D. Blume

    Research output: Contribution to journalArticle

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    Abstract

    Background: Adults with congenital heart disease represent an expanding and unique population of patients with heart failure (HF) in whom the use of mechanical circulatory support (MCS) has not been characterized. We sought to describe overall use, patient characteristics, and outcomes of MCS in adult congenital heart disease (ACHD). Methods: All patients entered into the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) between June 23, 2006, and December 31, 2015, were included. Patients with ACHD were identified using pre-operative data and stratified by ventricular morphology. Mortality was compared between ACHD and non-ACHD patients, and multivariate analysis was performed to identify predictors of death after device implantation. Results: Of 16,182 patients, 126 with ACHD stratified as follows: systemic morphologic left ventricle (n = 63), systemic morphologic right ventricle (n = 45), and single ventricle (n = 17). ACHD patients were younger (42 years ± 14 vs 56 years ± 13; p < 0.0001) and were more likely to undergo device implantation as bridge to transplant (45% vs 29%; p < 0.0001). A higher proportion of ACHD patients had biventricular assist device (BiVAD)/total artificial heart (TAH) support compared with non-ACHD patients (21% vs 7%; p < 0.0001). More ACHD patients on BiVAD/TAH support were INTERMACS profile 1 compared with patients on systemic left ventricular assist device (LVAD) support (35% vs 15%; p = 0.002). ACHD and non-ACHD patients with LVADs had similar survival; survival was worse for patients on BIVAD/TAH support. BiVAD/TAH support was the only variable independently associated with mortality (early phase hazard ratio 4.4; 95% confidence interval, 1.8-11.1; p = 0.001). For ACHD patients receiving MCS, ventricular morphology was not associated with mortality. Conclusions: ACHD patients with LVADs have survival similar to non-ACHD patients. Mortality is higher for patients requiring BiVAD/TAH support, potentially owing to higher INTERMACS profile. These outcomes suggest a promising role for LVAD support in ACHD patients as part of the armamentarium of therapies for advanced HF.

    LanguageEnglish (US)
    JournalJournal of Heart and Lung Transplantation
    DOIs
    StateAccepted/In press - 2017

    Fingerprint

    Registries
    Heart Diseases
    Artificial Heart
    Equipment and Supplies
    Heart-Assist Devices
    Mortality
    Heart Ventricles
    Survival
    Heart Failure

    Keywords

    • Congenital heart disease
    • LVAD
    • Mechanical circulatory support
    • Single ventricle
    • Total artificial heart
    • Ventricular assist device

    ASJC Scopus subject areas

    • Surgery
    • Pulmonary and Respiratory Medicine
    • Cardiology and Cardiovascular Medicine
    • Transplantation

    Cite this

    Outcomes following implantation of mechanical circulatory support in adults with congenital heart disease : An analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). / VanderPluym, Christina J.; Cedars, Ari; Eghtesady, Pirooz; Maxwell, Bryan G.; Gelow, Jill M.; Burchill, Luke J.; Maltais, Simon; Koehl, Devin A.; Cantor, Ryan S.; Blume, Elizabeth D.

    In: Journal of Heart and Lung Transplantation, 2017.

    Research output: Contribution to journalArticle

    VanderPluym, Christina J. ; Cedars, Ari ; Eghtesady, Pirooz ; Maxwell, Bryan G. ; Gelow, Jill M. ; Burchill, Luke J. ; Maltais, Simon ; Koehl, Devin A. ; Cantor, Ryan S. ; Blume, Elizabeth D./ Outcomes following implantation of mechanical circulatory support in adults with congenital heart disease : An analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). In: Journal of Heart and Lung Transplantation. 2017
    @article{c51a07d27aaf41e1a0a7f0bed16e337a,
    title = "Outcomes following implantation of mechanical circulatory support in adults with congenital heart disease: An analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)",
    abstract = "Background: Adults with congenital heart disease represent an expanding and unique population of patients with heart failure (HF) in whom the use of mechanical circulatory support (MCS) has not been characterized. We sought to describe overall use, patient characteristics, and outcomes of MCS in adult congenital heart disease (ACHD). Methods: All patients entered into the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) between June 23, 2006, and December 31, 2015, were included. Patients with ACHD were identified using pre-operative data and stratified by ventricular morphology. Mortality was compared between ACHD and non-ACHD patients, and multivariate analysis was performed to identify predictors of death after device implantation. Results: Of 16,182 patients, 126 with ACHD stratified as follows: systemic morphologic left ventricle (n = 63), systemic morphologic right ventricle (n = 45), and single ventricle (n = 17). ACHD patients were younger (42 years ± 14 vs 56 years ± 13; p < 0.0001) and were more likely to undergo device implantation as bridge to transplant (45{\%} vs 29{\%}; p < 0.0001). A higher proportion of ACHD patients had biventricular assist device (BiVAD)/total artificial heart (TAH) support compared with non-ACHD patients (21{\%} vs 7{\%}; p < 0.0001). More ACHD patients on BiVAD/TAH support were INTERMACS profile 1 compared with patients on systemic left ventricular assist device (LVAD) support (35{\%} vs 15{\%}; p = 0.002). ACHD and non-ACHD patients with LVADs had similar survival; survival was worse for patients on BIVAD/TAH support. BiVAD/TAH support was the only variable independently associated with mortality (early phase hazard ratio 4.4; 95{\%} confidence interval, 1.8-11.1; p = 0.001). For ACHD patients receiving MCS, ventricular morphology was not associated with mortality. Conclusions: ACHD patients with LVADs have survival similar to non-ACHD patients. Mortality is higher for patients requiring BiVAD/TAH support, potentially owing to higher INTERMACS profile. These outcomes suggest a promising role for LVAD support in ACHD patients as part of the armamentarium of therapies for advanced HF.",
    keywords = "Congenital heart disease, LVAD, Mechanical circulatory support, Single ventricle, Total artificial heart, Ventricular assist device",
    author = "VanderPluym, {Christina J.} and Ari Cedars and Pirooz Eghtesady and Maxwell, {Bryan G.} and Gelow, {Jill M.} and Burchill, {Luke J.} and Simon Maltais and Koehl, {Devin A.} and Cantor, {Ryan S.} and Blume, {Elizabeth D.}",
    year = "2017",
    doi = "10.1016/j.healun.2017.03.005",
    language = "English (US)",
    journal = "Journal of Heart and Lung Transplantation",
    issn = "1053-2498",
    publisher = "Elsevier USA",

    }

    TY - JOUR

    T1 - Outcomes following implantation of mechanical circulatory support in adults with congenital heart disease

    T2 - Journal of Heart and Lung Transplantation

    AU - VanderPluym,Christina J.

    AU - Cedars,Ari

    AU - Eghtesady,Pirooz

    AU - Maxwell,Bryan G.

    AU - Gelow,Jill M.

    AU - Burchill,Luke J.

    AU - Maltais,Simon

    AU - Koehl,Devin A.

    AU - Cantor,Ryan S.

    AU - Blume,Elizabeth D.

    PY - 2017

    Y1 - 2017

    N2 - Background: Adults with congenital heart disease represent an expanding and unique population of patients with heart failure (HF) in whom the use of mechanical circulatory support (MCS) has not been characterized. We sought to describe overall use, patient characteristics, and outcomes of MCS in adult congenital heart disease (ACHD). Methods: All patients entered into the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) between June 23, 2006, and December 31, 2015, were included. Patients with ACHD were identified using pre-operative data and stratified by ventricular morphology. Mortality was compared between ACHD and non-ACHD patients, and multivariate analysis was performed to identify predictors of death after device implantation. Results: Of 16,182 patients, 126 with ACHD stratified as follows: systemic morphologic left ventricle (n = 63), systemic morphologic right ventricle (n = 45), and single ventricle (n = 17). ACHD patients were younger (42 years ± 14 vs 56 years ± 13; p < 0.0001) and were more likely to undergo device implantation as bridge to transplant (45% vs 29%; p < 0.0001). A higher proportion of ACHD patients had biventricular assist device (BiVAD)/total artificial heart (TAH) support compared with non-ACHD patients (21% vs 7%; p < 0.0001). More ACHD patients on BiVAD/TAH support were INTERMACS profile 1 compared with patients on systemic left ventricular assist device (LVAD) support (35% vs 15%; p = 0.002). ACHD and non-ACHD patients with LVADs had similar survival; survival was worse for patients on BIVAD/TAH support. BiVAD/TAH support was the only variable independently associated with mortality (early phase hazard ratio 4.4; 95% confidence interval, 1.8-11.1; p = 0.001). For ACHD patients receiving MCS, ventricular morphology was not associated with mortality. Conclusions: ACHD patients with LVADs have survival similar to non-ACHD patients. Mortality is higher for patients requiring BiVAD/TAH support, potentially owing to higher INTERMACS profile. These outcomes suggest a promising role for LVAD support in ACHD patients as part of the armamentarium of therapies for advanced HF.

    AB - Background: Adults with congenital heart disease represent an expanding and unique population of patients with heart failure (HF) in whom the use of mechanical circulatory support (MCS) has not been characterized. We sought to describe overall use, patient characteristics, and outcomes of MCS in adult congenital heart disease (ACHD). Methods: All patients entered into the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) between June 23, 2006, and December 31, 2015, were included. Patients with ACHD were identified using pre-operative data and stratified by ventricular morphology. Mortality was compared between ACHD and non-ACHD patients, and multivariate analysis was performed to identify predictors of death after device implantation. Results: Of 16,182 patients, 126 with ACHD stratified as follows: systemic morphologic left ventricle (n = 63), systemic morphologic right ventricle (n = 45), and single ventricle (n = 17). ACHD patients were younger (42 years ± 14 vs 56 years ± 13; p < 0.0001) and were more likely to undergo device implantation as bridge to transplant (45% vs 29%; p < 0.0001). A higher proportion of ACHD patients had biventricular assist device (BiVAD)/total artificial heart (TAH) support compared with non-ACHD patients (21% vs 7%; p < 0.0001). More ACHD patients on BiVAD/TAH support were INTERMACS profile 1 compared with patients on systemic left ventricular assist device (LVAD) support (35% vs 15%; p = 0.002). ACHD and non-ACHD patients with LVADs had similar survival; survival was worse for patients on BIVAD/TAH support. BiVAD/TAH support was the only variable independently associated with mortality (early phase hazard ratio 4.4; 95% confidence interval, 1.8-11.1; p = 0.001). For ACHD patients receiving MCS, ventricular morphology was not associated with mortality. Conclusions: ACHD patients with LVADs have survival similar to non-ACHD patients. Mortality is higher for patients requiring BiVAD/TAH support, potentially owing to higher INTERMACS profile. These outcomes suggest a promising role for LVAD support in ACHD patients as part of the armamentarium of therapies for advanced HF.

    KW - Congenital heart disease

    KW - LVAD

    KW - Mechanical circulatory support

    KW - Single ventricle

    KW - Total artificial heart

    KW - Ventricular assist device

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    DO - 10.1016/j.healun.2017.03.005

    M3 - Article

    JO - Journal of Heart and Lung Transplantation

    JF - Journal of Heart and Lung Transplantation

    SN - 1053-2498

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