Ventricular assist device implantation in children with a mechanical valve: An ACTION registry analysis.

BACKGROUND

Patients with congenital heart disease (CHD) frequently have had valve interventions, including replacement with a mechanical valve (mechV). The impact of a mechV on clinical outcomes in patients undergoing ventricular assist device (VAD) implantation is not well characterized.

OBJECTIVES

This study assessed VAD outcomes in patients with CHD and a mechV.

METHODS

All patients with a history of CHD ( = 433) in the Advanced Cardiac Therapies Improving Outcomes Network database were included in the study (January 2012-January 2023). Patient characteristics and outcomes were assessed among patients with a mechV and without a mechV.

RESULTS

Twenty-seven (6%) patients with CHD had a mechV at VAD implantation. Fourteen (52%) of the patients with mechV had univentricular anatomy and 13 (48%) had biventricular anatomy. Patients with mechV were older (4.9 vs 1.9 years,  = 0.02), smaller (14.9 vs 10.6 kg,  = 0.02), and had a higher interagency registry for mechanically assisted circulatory support profile ( = 0.01). Three (11%) patients with mechV experienced a valve-related complication. There was no difference in survival ( = 0.4) or ischemic stroke frequency (11% vs 13%,  = 1) between patients with mechV and non-mechV. Patients with mechV had higher frequency of hemorrhagic stroke (18% vs 4.7%,  = 0.01) and major bleeding (44% vs 26%,  = 0.04).

CONCLUSIONS

Patients with CHD with a mechV have similar survival to patients with non-mechV; however, there is higher risk of bleeding including hemorrhagic stroke.