Comparing Outcomes of Heartmate 3 and Heart Transplantation in Older Children With Dilated Cardiomyopathy—Can Transplantation be Delayed or Avoided?
Waldemar F. Carlo, Luz A. Padilla, James K. Kirklin, Ryan S. Cantor, Devin Koehl, Jeffrey P. Jacobs, Shahnawaz Amdani, Kathryn Chatfield, Manan Desai, Gabrielle Vaughn, Catherine M. Montgomery, Katerina Boucek, Katheryn Gambetta, David L. S. MoralesABSTRACT
Background
Children with end‐stage dilated cardiomyopathy (DCM) usually undergo heart transplantation or a short‐term bridge with a ventricular assist device. Heartmate 3 (HM3) may represent an appealing longer‐term option, though pediatric data are limited. We analyzed two clinical registries and hypothesized that adolescents with DCM treated with either HM3 or transplant would present similar survival.
Methods
The Pedimacs and Pediatric Heart Transplant Society registries were queried for DCM patients ages 10–18 years treated with HM3 or transplant, between 2017 and 2022. Mortality and adverse events were reported.
Results
Ninety HM3 and 306 transplant patients were reported within the respective registries. There was a higher proportion of Black patients in the HM3 cohort (40% vs. 30% in the transplant cohort, p = 0.03). Twelve‐ and 36‐month survival rates were both 94.4% for HM3 patients and were 99.3% and 95.6% for transplant patients. In the HM3 group, there were 66 transplants (median time of 2.8 months), 3 late explants for recovery, and 3 early deaths. Conditional 1‐year survival for HM3 and transplant was 100% and 96.3%, respectively, at 3 years. In the HM3 group, bleeding, stroke, and device malfunction rates were low at 0.1 events per patient per year.
Conclusions
Adolescents with DCM treated with either HM3 or transplant had excellent 3‐year outcomes, though many HM3 pediatric patients are transplanted early after device placement. Safely supporting this group of patients for an extended duration with HM3 has implications for delaying/avoiding transplantation, longer‐term patient survival, and donor organ availability.