TY - JOUR
T1 - Cognitive outcomes in pediatric heart transplant recipients bridged to transplantation with ventricular assist devices
AU - Stein, Mary Lynette
AU - Bruno, Jennifer L.
AU - Konopacki, Kelly L.
AU - Kesler, Shelli
AU - Reinhartz, Olaf
AU - Rosenthal, David
N1 - Funding Information:
The other authors have no conflicts of interest to disclose. This study was supported by a Stanford Medical Student Scholars Fellowship.
PY - 2013/2
Y1 - 2013/2
N2 - Background: Ventricular assist devices (VADs) have been associated with high rates of neurologic injury in pediatric patients during the period of support, but the delayed consequences of this type of injury have not been described in the literature. Methods: In this study we assess cognitive outcomes with indices of general intellectual functioning, including working memory, processing speed, perceptual reasoning and verbal comprehension, for pediatric heart transplant recipients who required VAD support as a bridge to transplant (n = 9). We present an aggregate of these VAD patients combined with heart transplant recipients who did not require mechanical circulatory support (n = 11), and compare the performance of all transplant patients (n = 20) to typically developing, healthy comparators (n = 12). We also present a post hoc analysis of those transplant recipients with significant medical morbidity in the first year of life, referred to as the high-risk transplant group (n = 5), and compare them with the low-risk transplant group (n = 15) and the typically developing comparators (n = 12). Results: The mean performance of the VAD patients was in the average range for each of the examined indices of cognitive functioning. A total of 11% of the VAD patients performed in the impaired range and 78% performed in the average range, with 11% in the superior range on measures of general intellectual functioning. The typically developing participants performed significantly better than the aggregated transplant recipients on all indices except verbal comprehension. Lower cognitive performance in the combined transplant group appears to be associated with medical morbidity in the first year of life. Conclusions: Despite significant neurologic risk factors, this cohort of pediatric patients who were bridged to transplant with VAD demonstrated resiliency in terms of cognitive outcomes. In this heterogeneous population, it is likely that multiple factors contributed to the cognitive outcomes. As VAD use becomes more common in pediatric patients, a prospective evaluation of cognitive outcomes is warranted.
AB - Background: Ventricular assist devices (VADs) have been associated with high rates of neurologic injury in pediatric patients during the period of support, but the delayed consequences of this type of injury have not been described in the literature. Methods: In this study we assess cognitive outcomes with indices of general intellectual functioning, including working memory, processing speed, perceptual reasoning and verbal comprehension, for pediatric heart transplant recipients who required VAD support as a bridge to transplant (n = 9). We present an aggregate of these VAD patients combined with heart transplant recipients who did not require mechanical circulatory support (n = 11), and compare the performance of all transplant patients (n = 20) to typically developing, healthy comparators (n = 12). We also present a post hoc analysis of those transplant recipients with significant medical morbidity in the first year of life, referred to as the high-risk transplant group (n = 5), and compare them with the low-risk transplant group (n = 15) and the typically developing comparators (n = 12). Results: The mean performance of the VAD patients was in the average range for each of the examined indices of cognitive functioning. A total of 11% of the VAD patients performed in the impaired range and 78% performed in the average range, with 11% in the superior range on measures of general intellectual functioning. The typically developing participants performed significantly better than the aggregated transplant recipients on all indices except verbal comprehension. Lower cognitive performance in the combined transplant group appears to be associated with medical morbidity in the first year of life. Conclusions: Despite significant neurologic risk factors, this cohort of pediatric patients who were bridged to transplant with VAD demonstrated resiliency in terms of cognitive outcomes. In this heterogeneous population, it is likely that multiple factors contributed to the cognitive outcomes. As VAD use becomes more common in pediatric patients, a prospective evaluation of cognitive outcomes is warranted.
KW - cognitive outcome
KW - heart failure
KW - heart transplantation
KW - mechanical circulatory support
KW - pediatrics
KW - ventricular assist device
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U2 - 10.1016/j.healun.2012.11.006
DO - 10.1016/j.healun.2012.11.006
M3 - Article
C2 - 23352393
AN - SCOPUS:84872837126
SN - 1053-2498
VL - 32
SP - 212
EP - 220
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 2
ER -