Marc Anders, MD,
Associate Professor
Texas Childrens Hospital
Houston, Texas
Disclosure information not submitted.
Title: Inotropic choice following pediatric heart transplantation does not affect outcomes
Introduction: Our study aims to describe the association of inotropic use, length of stay (LOS), and discharge mortality in pediatric heart transplantations (HTx) with respect to orthotopic HTx only and those pre-operatively supported with ventricular assist devices (VAD) and/or extra-corporeal membrane oxygenation (ECMO).
Methods: Utilizing the Pediatric Health Information System database, we analyzed all pediatric patients <19 years who underwent a single heart transplant from 2010-2019. We excluded those who required post-operative VAD or ECMO support. Patients were divided into only HTx (OHTx), pre-transplant ECMO and HTx (ECMO+HTx), pre-transplant VAD (VAD+HTx), and ECMO and VAD (ECMO+VAD+HTx). Continuous variables were expressed in median [interquartile range]; univariate and multivariate analyses were used.
Results: We identified 2,386 patients. The overall mortality was 2%, age 5 years [0-13], 55% male, predominantly 65% white race, 59% with congenital heart disease, intensive care unit (ICU) LOS 22 days [8-60] and hospital LOS 56 days [22-112]. 96% of patients received two or more inotropes: milrinone 98%, epinephrine (EPI) 92%, dopamine (DOP) 42%, isoproterenol (ISO) 31% and dobutamine (DOB) 7%; with a significant decreased use of DOP, DOB, ISO, and significant increase of EPI during the study period, p< 0.01. An increased relative risk (RR) of mortality was associated with presence of CHD, p< 0.01, in which group also an increased use of epinephrine, p< 0.01, was observed. Of the cohort, 84% received OHTx, 8% VAD+HTx, 5% ECMO+HTx, and 3% ECMO+VAD+HTx, with the discharge mortality being 2%, 1%, 2%, and 8%, respectively. An increased RR of mortality was associated with the ECMO+VAD cohort, p< 0.01, and the use of epinephrine, p=0.05. ICU LOS was shortest in OHTx with 16 days [7-47], and longest in ECMO+VAD+HTx with 81 days [46-126], p< 0.01. Hospital LOS was shortest in OHTx with 47 days [19-101], and longest in ECMO+VAD+HTx with 126 days [79-164], p< 0.01. In multivariate analysis, only the presence of CHD and pre-HTx support with ECMO+VAD increased mortality.
Conclusion: In our analysis, we demonstrated that the choice of inotropic use after pediatric HTx does not appear to affect discharge mortality, however the presence of CHD and pre-transplant use of ECMO+VAD were associated with increased mortality.