Outpatient continuous parenteral inotropic therapy as bridge to transplantation in children with advanced heart failure

BackgroundAdvanced heart failure in children is associated with high morbidity and mortality and is often refractory to standard medical therapy. The purpose of this study was to review our institutional experience with the use of outpatient parenteral inotropic therapy (PIT) for advanced chronic heart failure in children.Methods and ResultsWe reviewed the medical records of all patients treated with PIT as outpatients. Seven patients received outpatient PIT from 2/99 to 1/05 (mean age was 14.6 years ± 3.7). Median duration of therapy was 10 weeks (range 4–84 weeks). The mean number of emergency department visits per patient was greater before starting PIT than after starting PIT (2.3 ± 1.8 versus 1.1 ± 2.2, P < .05). The mean number of hospital admissions from exacerbation of heart failure symptoms decreased after starting PIT (2.1 ± 1.3 versus 0.6 ± 0.8, P < .05). Mean EF% in patients with systolic dysfunction improved while on therapy (30 ± 14% before versus 39 ± 16% after, P < .05). There was 1 death and 5 complications in 2 patients. Six patients were successfully bridged to transplantation.ConclusionOutpatient continuous parenteral inotropic therapy may serve as a successful bridge to cardiac transplantation in selected pediatric outpatients.