• Parthak Prodhan, Giridhar Kalikivenkata, Xinyu Tang, Kassandra Thomas, Jonathan Byrnes, Michiaki Imamura, Robert D B Jaquiss, Xiomara Garcia, Elizabeth A Frazier, Adnan T Bhutta, and Umesh Dyamenahalli.
• Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas. Electronic address: prodhanparthak@uams.edu.
• Ann. Thorac. Surg. 2015 May 1;99(5):1713-8.

BackgroundPatients with end-stage heart failure possess many attributes that place them at risk for prolonged mechanical ventilation (MV). However, there are only limited data on MV support among children after ventricular assist device (VAD) implantation. We report the duration of MV after VAD placement, indications for respiratory support in the postimplantation period, and associated patient factors.MethodsThis single-center retrospective study included 43 consecutive children (aged <18 years) with end-stage heart failure who were supported with a VAD as a bridge to transplantation from January 2005 to December 2011. Multivariable analysis was performed using the multiple Poisson regression model for the duration of MV.ResultsOverall, 33% (n = 14) remained on MV until heart transplant or death. Of those requiring pre-VAD extracorporeal membrane oxygenation (ECMO) support, 63% (n = 12 of 19) remained on MV until heart transplant or death compared with 8% (n = 2 of 24) among those not on ECMO before VAD (p < 0.001). Patients with moderate or severe mitral regurgitation while on VAD support had 1.7-times more MV days compared with those with none or trivial on-VAD mitral regurgitation. In addition, previous support on ECMO, those with moderate or severe tricuspid regurgitation, and those with only left VAD implants had an increased risk of prolonged MV.ConclusionsOur results suggest that VAD recipients previously supported on ECMO, those with moderate or severe mitral regurgitation, moderate or severe tricuspid regurgitation, and those with only left VAD implants had an increased risk of prolonged MV. Future studies in larger cohorts are necessary to confirm the findings from this single-institutional experience.Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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