In the United States, Half of all Children on a Ventricular Assist Device Overcome Intellectual and Motor Disabilities After Heart Transplantation!

A. Mehdizadeh-Shrifi¹, M. Faateh¹, H. F.. Ahmed¹, A. Ramineni², L. Mangano³, T. Menninger³, A. Lorts³, A. Ashfaq¹, M. Ricci⁴, D. Morales^5
1Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio ²Cincinnati Children’s Hospital, Cincinnati, Ohio ³Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio ⁴Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Iowa City, Ohio ⁵Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical CenterCincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Purpose: Ventricular assist devices (VAD) are associated with high rates of neurological complications, which can significantly affect neuro-psychological and motor development. The authors sought to investigate if children on a VAD continue to exhibit cognitive, motor, and academic impairment post-heart transplant (HTx) and their ability to overcome these deficits.

Methods: The United Network for Organ Sharing (UNOS) was queried for patients (≤18-years) who underwent VAD implantation followed by HTx (1986-2024). Psychomotor development, academic levels, and academic progress information were obtained from questionnaire data (five-point Likert scale) recorded by individual transplant centers pre-HTx and at post-HTx follow-ups.
Children were classified as having psychomotor impairment if they had cognitive and motor deficits at time of HTx. Patients with probable or questionable deficits were considered impaired if heavily compromised academic performance/participation delayed grade level, or special education was present pre-HTx. Children had no impairment if cognitive and motor development were age appropriate. Post-HTx outcomes assessed were survival, psychomotor development, academic levels, and progress.

Results: In total, 1,292 children on a VAD with complete psychomotor assessment who underwent HTx were identified. Psychomotor impairment was present in 522(40%,522/1,292), and 770(60%,770/1,292) had no impairment pre-HTx. Amongst children with pre-HTx psychomotor impairment, 49%(255/522) were in age-group 0-5(p < 0.001).

Almost one-third(31%,162/522) of children with pre-HTx psychomotor impairment underwent transplantation for congenital heart disease. Children with psychomotor impairment demonstrated higher rates of government insurance(Impairment:60% vs. No-Impairment:50%,p 0.002) and lower functional-status( < 30%) (Impairment:20% vs. No-Impairment:17%,p < 0.001) at time of transplantation. In era I, incidences of VADs with impairment were 13%(69/205), 38%(133/351) in era II and 44%(320/736) in era III.

Post-HTx outcomes of children with pre-HTx impairment showed that more than half had no cognitive (n=278/522,53%) and no motor impairment (n=338/522,65%) at last follow-up at 3.8[1-6] years.
More than half of all children with pre-HTx impairment achieved full academic performance (302/522,58%) and were within one grade level of peers(282/522,54%) post-tx.
Post-HTx outcomes of children with no pre-HTx impairment showed that almost all remained without cognitive (675/770,88%) and motor impairment (713/722,93%) at last follow-up at 4.5[1-7] years. The majority achieved full academic performance (613/722,80%) and were within one grade level of peers (627/722,82%). The median survival was reduced in children with pre-HTx psychomotor-impairment(Impairment:9.6[9.1-10.1]vs.No-Impairment:11[10.5-1.3],log-rank:0.002).

Conclusion: Half of all children on VAD with psychomotor-impairment had no deficits and excellent educational milestones at their last follow-up. Children without impairment remained almost all free of deficits. Despite compromised survival rates and increasing incidences, the present report underscores that children on VAD can successfully overcome deficits and exceed expectations.

Identify the source of the funding for this research project: No funding