Neurologic and Cognitive Assessment of Children after Ventricular Assist Device (VAD) and Heart Transplantation

Objectives: Heart transplantation (HTx) in children is a recognized therapy for terminal heart failure. Ventricular assist devices (VAD) are able to bridge the time until actual transplantation (BTT) or in some cases to recovery (BTR). The assist device implantation, the cardiac transplantation and the waiting time all have a severe impact on the psychological and physiological development of the young patient.

We set out to examine the neurological outcome and the quality of life in children who received an assist device as a BTT or BTR at the LMU university clinic in Munich between 1992 and 2016.

Methods: Of a total of 145 heart transplanted children, 39 patients were included as they had a VAD implanted (age range at VAD implantation: 1.5 months to 24.31 years, median 8.51): 17 patients died: 10 during the VAD therapy while waiting for HTx and 7 after HTx during later follow-up leaving 22 patients to examine in our study (BTT n = 21 ; BTR n = 1). The methods to assess our patients included an extended child specific neurological examination (MND) and the Epitrack Test for patients of 6 years and above (n = 18). Further age-adapted quality of life questionnaires were handed out to all 22 patients (Eq. 5D, Eq. 5D-Y, Kidscreen). Both Eq. 5D questionnaires included a visual analogue scale (VAS) where the patient needed to range their actual quality of life between 0 and 100.

Results:

Method	n	Results
MND	13	Normal n = 11 ; light problems n = 1 ; complex problems n = 1
Epitrack Jr	7	mid result: 30.55 (SD: 9.1)
Epitrack adult	8	mid result: 30.25 (SD: 2.99)
Eq. 5D - VAS	15	average 82.3 (min 50; max 100)

A large majority of the patients showed normal results at the neurological examination (n = 11 out of 13). The Epitrack testing revealed slightly impaired but still surprisingly good results. Children performed in the average 7.36% and adults 13.82% below the normal population results. The results of the Eq. 5D visual analog scale turned out to be better when compared with those of patients with other diseases; for example, children with Diabetes mellitus type 1 picked 80.2 range 77.6–82.7(Murillo 2017).

Conclusion: Thus, in children with VAD for BTT or BTR, cognitive development overall is encouragingly positive, so that most patients achieve a normal social, school and professional life. As the small patient number of our study is a limiting factor, further studies to confirm our findings are warranted.