Multicenter outcomes for ventricular assist device support for failed stage II palliation

Background Ventricular assist device (VAD) use for failed stage II palliation (S2P) is increasing with limited data on outcomes.Methods To address this knowledge gap, we conducted a multicenter retrospective review of the Advanced Cardiac Therapies Improving Outcomes Network registry. We leveraged the registry to analyze data on the clinical course, complications, and survival of systemic VADs (SVAD) after S2P.Results We identified 34 patients from 15 centers between 2012 and 2022 implanted at median age of 1.8 years [interquartile range (IQR) 0.9-2.7]; 85% had systemic right ventricles and all patients underwent at least one sternotomy. Preimplant, all but 1 patient had an Interagency Registry for Mechanically Assisted Circulatory Support profile of 1-2, with 62% being on ≥2 inotropes, 50% total parenteral nutrition dependent, 38% mechanically ventilated, and 20% on extracorporeal membrane oxygenation in the week preceding implant. Device strategy was variable with 70% being on continuous flow devices and the remaining on pulsatile support. Multiple device strategies were utilized in 32% of patients. Median time on VAD support was 74 days [IQR 30-186]. Adverse events were frequent and included infection (47%), strokes (29%), bleeding (26%), dialysis (15%), and respiratory failure (9%). Bleeding complications (p = 0.0004), respiratory failure (p = 0.04), and multiple inotropes preimplant (p = 0.046) were associated with in-hospital mortality. Overall survival to transplant/recovery was seen in 76% and to 1-year postexplant in 56%.Conclusion Encouraging clinical outcomes are seen with SVAD use for failed S2P even in the face of frequent adverse events and wide center variability in device strategy. Ongoing multi-institutional collaboration is required to better understand optimal SVAD support strategies.