Can Children With a VAD Overcome Intellectual and Motor Disabilities After Heart Transplantation in the United States?

Abstract

Ventricular assist devices (VADs) can be associated with high rates of neurologic complications. This study investigated whether children with VADs continue to exhibit psychomotor impairment after heart transplantation (HTx). The United Network for Organ Sharing was queried for children who underwent VAD implantation and HTx (2008-2024). Cognitive or motor impairment was assessed using a 4-point Likert scale at the HTx center. Cognitive or motor impairments were defined as psychomotor impairments and were analyzed before and after HTx. Of 1417 children bridged to HTx with VADs, 204 had pre-HTx psychomotor impairment. Children with psychomotor impairments were younger (median impaired, 2 years [interquartile range, 0-8 years] vs median not impaired, 9 years [interquartile range, 2-14 years]; P < .001) and had higher rates of congenital heart disease (impaired, 31%, vs not impaired, 16%; P < .001). Outcomes at the last follow-up showed that more than one-half of impaired children were without impairment at last follow-up (51%; n = 104). Children bridged to HTx with VADs were more likely to be without impairment after HTx than were children who underwent HTx without VADs (VAD with no impairment, 51% vs no VAD with no impairment, 42%; P < .035). Multivariate analysis highlighted that high functional pre-HTx status (odds ratio, 3.43; CI, 2.01-5.09; P < .001) was the strongest predictor of overcoming psychomotor impairment. Survival of children bridged with VADs was significantly compromised by psychomotor impairment, yet this analysis demonstrated that more than one-half of these patients overcame their impairments. Children with psychomotor impairments who were awaiting HTx were more likely to resolve their impairments when bridged with VADs compared with children without VADs. However, psychomotor impairment was a significant harbinger of poor long-term survival and should be a focus of targeted intervention.