Outcomes following implantation of mechanical circulatory support in adults with congenital heart disease: An analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS)
Section snippets
INTERMACS database and study population
The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) is a national prospective database of >16,000 patients in the United States supported on durable MCS devices approved by the Food and Drug Administration. The database is a collaboration between the US National Heart, Lung, and Blood Institute, US Food and Drug Administration, US Centers for Medicare and Medicaid Services, industry, and implantation centers. All registry data are monitored by an independent
Study population
Among 16,182 patients in the INTERMACS database, 126 were identified as having ACHD (Figure 1). Of 158 centers contributing to the INTERMACS registry, only 59 were responsible for all 126 patients, with >70% of centers contributing only 1 or 2 patients (Figure 2). The 6 centers that had the highest volume of ACHD patients on MCS (5 or 6 patients) were high-volume implantation centers with a median non-ACHD implantation volume of 320 patients (range, 236–412 patients) compared with the 41
Discussion
In this article, we present an INTERMACS analysis of the utilization practices, patient characteristics, and outcomes of MCS in patients with ACHD. ACHD patients differed most notably from non-ACHD patients in expected ways, including younger age, greater allosensitization, more right ventricular dysfunction, and unfavorable mediastinal anatomy at time of device implantation. As a group, ACHD patients had higher rates of mortality and adverse events than non-ACHD patients; however, the
Disclosure statement
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
This study was funded in part by support from the Cardiac Transplant and Education Fund at Boston Children’s Hospital.
References (34)
- et al.
Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis
J Am Coll Cardiol
(2011) - et al.
Estimating the congenital heart disease population in the United States in 2010—what are the numbers?
J Am Coll Cardiol
(2012) - et al.
Trends in hospitalizations for adults with congenital heart disease in the U.S
J Am Coll Cardiol
(2009) - et al.
Mode of death in adults with congenital heart disease
Am J Cardiol
(2000) - et al.
Seventh INTERMACS annual report: 15,000 patients and counting
J Heart Lung Transplant
(2015) - et al.
A United Network for Organ Sharing analysis of heart transplantation in adults with congenital heart disease: outcomes and factors associated with mortality and retransplantation
J Thorac Cardiovasc Surg
(2010) - et al.
Organ allocation in adults with congenital heart disease listed for heart transplant: impact of ventricular assist devices
J Heart Lung Transplant
(2013) - et al.
Would access to device therapies improve transplant outcomes for adults with congenital heart disease? Analysis of the United Network for Organ Sharing (UNOS)
J Heart Lung Transplant
(2011) - et al.
Bridge to transplantation with a left ventricular assist device for systemic ventricular failure after Mustard procedure
Ann Thorac Surg
(2007) - et al.
Left ventricular assist device for right side assistance in patients with transposition
Ann Thorac Surg
(2002)
Implantation of a left ventricular assist device, back-to-front, in an adolescent with a failing mustard procedure
J Thorac Cardiovasc Surg
Mechanical circulatory support in patients with heart failure secondary to transposition of the great arteries
J Heart Lung Transplant
Effect of mechanical assistance of the systemic ventricle in single ventricle circulation with cavopulmonary connection
J Thorac Cardiovasc Surg
Trends and outcomes in transplantation for complex congenital heart disease: 1984 to 2004
Ann Thorac Surg
Improved survival of patients with end-stage heart failure listed for heart transplantation: analysis of organ procurement and transplantation network/U.S. United Network of Organ Sharing data, 1990 to 2005
J Am Coll Cardiol
Mechanical circulatory support pathways that maximize post-heart transplant survival
Ann Thorac Surg
Wait-list outcomes for adults with congenital heart disease listed for heart transplantation in the U.S.
J Am Coll Cardiol
Cited by (97)
Heart Transplantation for Adults With Congenital Heart Disease Can Be Performed at Adult or Pediatric Hospitals With Comparable Outcomes
2024, Journal of Surgical ResearchAdults with Congenital Heart Disease and Transplant: Challenges, Opportunities, and Policy
2024, Heart Failure ClinicsSurgical Considerations in Adult Congenital Heart Disease Heart Failure
2024, Heart Failure ClinicsCardiogenic shock in adults with congenital heart disease: Insights from the FRENSHOCK registry
2023, Archives of Cardiovascular DiseasesVentricular assist device for end-stage adult congenital heart disease patients: Current status
2023, Journal of Cardiology
- 1
These authors have contributed equally to this work.