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2 results on '"David M. Peng"'

1. Impact of HeartWare ventricular assist device discontinuation on the pediatric population: An Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry analysis

Author

Robert A. Niebler, MD, Muhammad Shezad, Mohammed Absi, MD, Othman A. Aljohani, MD, Shahnawaz Amdani, MD, Scott Auerbach, MD, David W. Bearl, MD, Katerina Boucek, MD, Holger Buchholz, MD, Chesney Castleberry, MD, John Dykes, MD, Kevin Engelhardt, MD, Joshua Friedland-Little, MD, Kyle Hope, MD MS, Mehreen Iqbal, MD, Aamir Jeewa, MD, Anna Joong, MD, Angela Lorts, MD, Lindsay May, MD, Deepa Mokshagundam, MD, Deipanjan Nandi, MD MSc, Matthew O'Connor, John J. Parent, MD, David M. Peng, MD, Natalie Shwaish, MD, Svetlana B. Shugh, MD, Christina VanderPluym, MD, Gabrielle Vaughn, MD, and Mattew Zinn, DO

Subjects
pediatric, mechanical circulatory support, ventricular assist device, complications, heart failure, Surgery, RD1-811, Specialties of internal medicine, RC581-951
Abstract

Background: The HeartWare ventricular assist device (HVAD) was discontinued in July 2021. The study aims to describe the impact the discontinuation the HVAD had on pediatric ventricular assist device (VAD) utilization and outcomes. Methods: The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry was queried for type of VAD utilization and outcomes/adverse event rates in patients with a body surface area of 0.7 to 1.4 m2. Results were compared from before and after July 2021. All patients in the registry implanted with an HVAD were reported to determine overall outcomes of these patients and define who remains on the device. Results: The HeartMate 3 (HM3) primarily replaced the HVAD in pediatric patients increasing from 29 of 258 (11%) of implants before July 2021 to 31 of 109 (29%) of implants after. A small increase in the use of the Berlin Heart EXCOR (40 of 258, 16% before to 20 of 109, 18% after) and paracorporeal continuous flow devices (116 of 258, 45% before to 58 of 109, 53% after) was also observed. The rate of ischemic stroke increased in the overall population and a decrease in bleeding complications in the EXCOR group was observed. Of the 187 pediatric patients implanted with an HVAD in the registry, 7 patients remain supported, 1 patient transitioned from the HVAD to an HM3, and 6 patients were lost to follow-up. Conclusions: The HM3 has been the primary replacement for the HVAD in the medium-sized pediatric population. The rate of ischemic stroke was higher after July 2021.

Published
2024
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2. Long-term surveillance biopsy: Is it necessary after pediatric heart transplant?

Author

Victoria Y. Ding, Seth A. Hollander, Doff B. McElhinney, Charlotte Sakarovitch, Tigran Khalapyan, David M. Peng, John C. Dykes, Christopher S. Almond, Manisha Desai, and David N. Rosenthal

Subjects
Graft Rejection, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Biopsy, 030232 urology & nephrology, Patient characteristics, Aftercare, Kaplan-Meier Estimate, 030230 surgery, Logistic regression, Article, Endomyocardial biopsy, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Risk Factors, Internal medicine, Cox proportional hazards regression, Medicine, Humans, Single institution, Child, Proportional Hazards Models, Heart transplantation, Transplantation, medicine.diagnostic_test, business.industry, Myocardium, Infant, Newborn, Infant, Logistic Models, Child, Preschool, Pediatrics, Perinatology and Child Health, Heart Transplantation, Female, business, Endocardium, Follow-Up Studies
Abstract

Due to limited and conflicting data in pediatric patients, long-term routine surveillance endomyocardial biopsy (RSB) in pediatric heart transplant (HT) remains controversial. We sought to characterize the rate of positive RSB and determine factors associated with RSB-detected rejection. Records of patients transplanted at a single institution from 1995 to 2015 with >2 year of post-HT biopsy data were reviewed for RSB-detected rejections occurring >2 year post-HT. We illustrated the trajectory of significant rejections (ISHLT Grade ≥3A/2R) among total RSB performed over time and used multivariable logistic regression to model the association between time and risk of rejection. We estimated Kaplan-Meier freedom from rejection rates by patient characteristics and used the log-rank test to assess differences in rejection probabilities. We identified the best-fitting Cox proportional hazards regression model. In 140 patients, 86% did not have any episodes of significant RSB-detected rejection >2 year post-HT. The overall empirical rate of RSB-detected rejection >2 year post-HT was 2.9/100 patient-years. The percentage of rejection among 815 RSB was 2.6% and remained stable over time. Years since transplant remained unassociated with rejection risk after adjusting for patient characteristics (OR = 0.98; 95% CI 0.78-1.23; P = 0.86). Older age at HT was the only factor that remained significantly associated with risk of RSB-detected rejection under multivariable Cox analysis (P = 0.008). Most pediatric patients did not have RSB-detected rejection beyond 2 years post-HT, and the majority of those who did were older at time of HT. Indiscriminate long-term RSB in pediatric heart transplant should be reconsidered given the low rate of detected rejection.

Published
2018

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