Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada.
Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Card Fail. 2022 Jun;28(6):982-990. doi: 10.1016/j.cardfail.2022.03.004. Epub 2022 Mar 14.
We evaluated the impact of pediatric heart-allocation policy changes over time and the approval of the Berlin ventricular assist device (VAD) on waitlist (WL) outcomes for children with congenital heart disease (CHD).
The Scientific Registry of Transplant Recipients database was evaluated to include all children (age < 18) with CHD and cardiomyopathy (CMP) on the WL between 1999 and 2019, divided into 4 eras: Era 1 (1999-2008); Era 2 (2009-2011); Era 3 (2012-2016); and Era 4 (2016-2019). WL characteristics and survival outcomes were evaluated for patients with CHD over time and were compared to those with CMP listed currently (Era 4).
We included 5185 children with CHD on the WL during the study period; 1999 (39%) were listed in Era 1; 693 (13%) in Era 2; 1196 (23%) in Era 3; and 1297 (25%) in Era 4. Compared to the CHD WL in eras 1 and 2, those in Era 4 were less likely to be infants (48% vs 49% vs 43%), on mechanical ventilation (30% vs 26% vs 19%), on extracorporeal membrane oxygenation (15% vs 9.7% vs 6.2%), and were more likely to be on a VAD (2.4% vs 2.2% vs 6.0%) (P < .05 for all). WL survival improved in children with CHD from Era 1 to Era 4 (P < .001). However, in Era 4, children with CHD had lower WL survival than those with CMP (P < .001).
Children with CHD are increasingly being listed with less advanced heart failure, and they have had improved WL survival over time; however, WL outcomes remain inferior to those with CMP. Advances in pediatric medical and VAD therapy may improve future WL outcomes.
我们评估了儿科心脏分配政策随时间的变化以及柏林心室辅助装置（VAD）获批对先天性心脏病（CHD）患儿候补名单（WL）结果的影响。
评估了移植受者科学登记处数据库，纳入 1999 年至 2019 年间 WL 上所有年龄<18 岁的 CHD 和心肌病（CMP）患儿，分为 4 个时期：时期 1（1999-2008 年）；时期 2（2009-2011 年）；时期 3（2012-2016 年）；时期 4（2016-2019 年）。随时间评估 CHD 患儿 WL 特征和生存结局，并与当前列入 CMP 的患儿进行比较（时期 4）。
本研究期间，共有 5185 例 CHD 患儿列入 WL；1999 年（39%）列入时期 1；693 例（13%）列入时期 2；1196 例（23%）列入时期 3；1297 例（25%）列入时期 4。与时期 1 和 2 的 CHD WL 相比，时期 4 的患儿更不可能是婴儿（48%比 49%比 43%），更少使用机械通气（30%比 26%比 19%），更少使用体外膜肺氧合（15%比 9.7%比 6.2%），而使用 VAD 的可能性更大（2.4%比 2.2%比 6.0%）（所有 P<.05）。CHD 患儿的 WL 生存率从时期 1 到时期 4 有所提高（P<.001）。然而，在时期 4，CHD 患儿的 WL 生存率低于 CMP 患儿（P<.001）。
CHD 患儿越来越多地被列入 WL，其心力衰竭程度较轻，随时间推移，其 WL 生存率有所提高；然而，WL 结局仍劣于 CMP。儿科医学和 VAD 治疗的进步可能会改善未来的 WL 结局。
