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The Increasing Utilization Of The Transvalvular Micro-axial Pump As A Bridge-to Transplant In Pediatrics Across The Usa
Amir Mehdizadeh-Shrifi, MD, Hosam Ahmed, MD, PhD, Muhammad Faateh, MBBS, Angela Lorts, MD, MBA, Tanya Perry, DO, Spencer Hogue, BS, David Morales, MD, Awais Ashfaq, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Objective(s):The use of Impella as a bridge-to-transplant (BTT) in children has been limited to single-center-studies. The authors sought to provide the first multi-institutional report of Impella-placement as BTT in children.
Methods:All patients(<18) who underwent Impella placement and heart-transplantation(HTx) from 1987-2022 were reviewed in the UNOS.
Results:The first transplanted child on Impella as BTT was in 2012 with 2017 the first year more than one was used as BTT. Median number used in era-I(2012-2016) was 1[0-1], era-II(2017-2019) 2[1-3] and eraIII(2020-2022) 9[7-10]. 27 were done in pediatric-centers and 7 at adult centers.6 patients with congenital heart disease(CHD) were performed in pediatric centers. 9(56%) Impella-5.0/5.5, 10 Impella-CP(29%),4(12%) Impella-2.5 and 1(3%) Impella-RP were used. 19(56%) patients went directly from Impella-to-transplant, 9(26%) received a durable-Ventricular Assist Device(VAD), 5(15%) had ECMO with Impella left ventricle-decompression and 1(3%) experienced device-failure but HTx. Days of Impella duration was 15(7-25). Time from Impella to a durable-VAD was 8-days(4-15). Follow-up was 728-days(367-1471) and post-transplant mortality was 9%(n=3) with 2(11%) deaths in BTT-patients and 1(11%) in bridge-to-durable-VAD-children. Mortality amongst CHD-patients post-transplant was 0%.
Conclusions:
The present report demonstrates the diverse and increasing use of Impella as BTT-strategy in children. While early outcomes are promising and utilization in congenital-heart programs has been increasing, further investigation is warranted to understand how this less invasive and versatile device can be used to maximize outcomes for children.
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