The impact of heart failure severity at time of listing for cardiac transplantation on survival in pediatric cardiomyopathy

Ranae L. Larsen, Charles E. Canter, David C. Naftel, Margaret Tressler, David N. Rosenthal, Elizabeth D. Blume, William T. Mahle, Delphine Yung, William R. Morrow, E. John Orav, James D. Wilkinson, Jeffrey A. Towbin, Steven E Lipshultz

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background The survival benefit of heart transplantation in adult heart failure is greatest for the sickest patients and negligible for patients not requiring inotropic or mechanical support. We hypothesized a similar survival benefit of heart transplantation for childhood cardiomyopathies with heart failure. Methods A merged data set of children registered in both the Pediatric Cardiomyopathy Registry and the Pediatric Heart Transplant Study was used to assess differences in mortality before and after transplant in patients with different levels of heart failure severity. Severity was scored 2 if mechanical ventilatory or circulatory support was required, 1 if intravenous inotropes were required, or 0 if no support was required. Results For 332 eligible children, 12-month mortality after listing was 9% for those with a severity score of 0 (n = 105), 16% with a score of 1 (n = 118), and 26% with a score of 2 (n = 109; p = 0.002) with a 3%, 8%, and 20% mortality with severity scores at listing of 0, 1, and 2, respectively, occurring before transplant. Patients listed with a score of 0 frequently deteriorated: 50% received an allograft or died before transplant with severity scores of 1 or 2. The risk of deterioration increased with previous surgery (relative risk, 3.84; p = 0.03) in the short-term and with lower left ventricular mass z-score at time of presentation (relative risk, 1.74; p = 0.003) in the longer-term. Conclusion Pediatric cardiomyopathy patients who require high levels of support receive a survival benefit from heart transplantation that is not shared by patients not requiring intravenous inotropic or mechanical support.

Original languageEnglish
Pages (from-to)755-760
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number7
DOIs
StatePublished - Jul 1 2011

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Heart Transplantation
Cardiomyopathies
Heart Failure
Pediatrics
Survival
Transplants
Mortality
Allografts
Registries

Keywords

  • cardiomyopathy
  • heart failure
  • heart transplantation
  • mortality
  • pediatrics

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Larsen, R. L., Canter, C. E., Naftel, D. C., Tressler, M., Rosenthal, D. N., Blume, E. D., ... Lipshultz, S. E. (2011). The impact of heart failure severity at time of listing for cardiac transplantation on survival in pediatric cardiomyopathy. Journal of Heart and Lung Transplantation, 30(7), 755-760. https://doi.org/10.1016/j.healun.2011.01.718

The impact of heart failure severity at time of listing for cardiac transplantation on survival in pediatric cardiomyopathy. / Larsen, Ranae L.; Canter, Charles E.; Naftel, David C.; Tressler, Margaret; Rosenthal, David N.; Blume, Elizabeth D.; Mahle, William T.; Yung, Delphine; Morrow, William R.; Orav, E. John; Wilkinson, James D.; Towbin, Jeffrey A.; Lipshultz, Steven E.

In: Journal of Heart and Lung Transplantation, Vol. 30, No. 7, 01.07.2011, p. 755-760.

Research output: Contribution to journalArticle

Larsen, RL, Canter, CE, Naftel, DC, Tressler, M, Rosenthal, DN, Blume, ED, Mahle, WT, Yung, D, Morrow, WR, Orav, EJ, Wilkinson, JD, Towbin, JA & Lipshultz, SE 2011, 'The impact of heart failure severity at time of listing for cardiac transplantation on survival in pediatric cardiomyopathy', Journal of Heart and Lung Transplantation, vol. 30, no. 7, pp. 755-760. https://doi.org/10.1016/j.healun.2011.01.718
Larsen, Ranae L. ; Canter, Charles E. ; Naftel, David C. ; Tressler, Margaret ; Rosenthal, David N. ; Blume, Elizabeth D. ; Mahle, William T. ; Yung, Delphine ; Morrow, William R. ; Orav, E. John ; Wilkinson, James D. ; Towbin, Jeffrey A. ; Lipshultz, Steven E. / The impact of heart failure severity at time of listing for cardiac transplantation on survival in pediatric cardiomyopathy. In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 7. pp. 755-760.
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abstract = "Background The survival benefit of heart transplantation in adult heart failure is greatest for the sickest patients and negligible for patients not requiring inotropic or mechanical support. We hypothesized a similar survival benefit of heart transplantation for childhood cardiomyopathies with heart failure. Methods A merged data set of children registered in both the Pediatric Cardiomyopathy Registry and the Pediatric Heart Transplant Study was used to assess differences in mortality before and after transplant in patients with different levels of heart failure severity. Severity was scored 2 if mechanical ventilatory or circulatory support was required, 1 if intravenous inotropes were required, or 0 if no support was required. Results For 332 eligible children, 12-month mortality after listing was 9{\%} for those with a severity score of 0 (n = 105), 16{\%} with a score of 1 (n = 118), and 26{\%} with a score of 2 (n = 109; p = 0.002) with a 3{\%}, 8{\%}, and 20{\%} mortality with severity scores at listing of 0, 1, and 2, respectively, occurring before transplant. Patients listed with a score of 0 frequently deteriorated: 50{\%} received an allograft or died before transplant with severity scores of 1 or 2. The risk of deterioration increased with previous surgery (relative risk, 3.84; p = 0.03) in the short-term and with lower left ventricular mass z-score at time of presentation (relative risk, 1.74; p = 0.003) in the longer-term. Conclusion Pediatric cardiomyopathy patients who require high levels of support receive a survival benefit from heart transplantation that is not shared by patients not requiring intravenous inotropic or mechanical support.",
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T1 - The impact of heart failure severity at time of listing for cardiac transplantation on survival in pediatric cardiomyopathy

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AU - Canter, Charles E.

AU - Naftel, David C.

AU - Tressler, Margaret

AU - Rosenthal, David N.

AU - Blume, Elizabeth D.

AU - Mahle, William T.

AU - Yung, Delphine

AU - Morrow, William R.

AU - Orav, E. John

AU - Wilkinson, James D.

AU - Towbin, Jeffrey A.

AU - Lipshultz, Steven E

PY - 2011/7/1

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N2 - Background The survival benefit of heart transplantation in adult heart failure is greatest for the sickest patients and negligible for patients not requiring inotropic or mechanical support. We hypothesized a similar survival benefit of heart transplantation for childhood cardiomyopathies with heart failure. Methods A merged data set of children registered in both the Pediatric Cardiomyopathy Registry and the Pediatric Heart Transplant Study was used to assess differences in mortality before and after transplant in patients with different levels of heart failure severity. Severity was scored 2 if mechanical ventilatory or circulatory support was required, 1 if intravenous inotropes were required, or 0 if no support was required. Results For 332 eligible children, 12-month mortality after listing was 9% for those with a severity score of 0 (n = 105), 16% with a score of 1 (n = 118), and 26% with a score of 2 (n = 109; p = 0.002) with a 3%, 8%, and 20% mortality with severity scores at listing of 0, 1, and 2, respectively, occurring before transplant. Patients listed with a score of 0 frequently deteriorated: 50% received an allograft or died before transplant with severity scores of 1 or 2. The risk of deterioration increased with previous surgery (relative risk, 3.84; p = 0.03) in the short-term and with lower left ventricular mass z-score at time of presentation (relative risk, 1.74; p = 0.003) in the longer-term. Conclusion Pediatric cardiomyopathy patients who require high levels of support receive a survival benefit from heart transplantation that is not shared by patients not requiring intravenous inotropic or mechanical support.

AB - Background The survival benefit of heart transplantation in adult heart failure is greatest for the sickest patients and negligible for patients not requiring inotropic or mechanical support. We hypothesized a similar survival benefit of heart transplantation for childhood cardiomyopathies with heart failure. Methods A merged data set of children registered in both the Pediatric Cardiomyopathy Registry and the Pediatric Heart Transplant Study was used to assess differences in mortality before and after transplant in patients with different levels of heart failure severity. Severity was scored 2 if mechanical ventilatory or circulatory support was required, 1 if intravenous inotropes were required, or 0 if no support was required. Results For 332 eligible children, 12-month mortality after listing was 9% for those with a severity score of 0 (n = 105), 16% with a score of 1 (n = 118), and 26% with a score of 2 (n = 109; p = 0.002) with a 3%, 8%, and 20% mortality with severity scores at listing of 0, 1, and 2, respectively, occurring before transplant. Patients listed with a score of 0 frequently deteriorated: 50% received an allograft or died before transplant with severity scores of 1 or 2. The risk of deterioration increased with previous surgery (relative risk, 3.84; p = 0.03) in the short-term and with lower left ventricular mass z-score at time of presentation (relative risk, 1.74; p = 0.003) in the longer-term. Conclusion Pediatric cardiomyopathy patients who require high levels of support receive a survival benefit from heart transplantation that is not shared by patients not requiring intravenous inotropic or mechanical support.

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