[II-AHAJS-08] New Heart Failure Therapeutics in CHD in the U.S
Pediatric heart failure has had a slow evolution of discovery of effective medications.Extrapolation of data from clinical trial results have permeated to pediatrics without showing the same efficacy. There have been few randomized controlled trials in pediatric heart failure in children with and without congenital heart disease (CHD). Recently, the PANORAMA HF trial in children with cardiomyopathy and decreased systolic function showed that sacubitril/valsartan produced a significant decrease in NT-pro BNP, but did not reach clinical significance at reducing symptoms or mortality. No patients with CHD were included on this trial. The carvedilol HF trial showed that concomitant use of carvedilol in children with CHD clinically disadvantaged children with RV systemic ventricle when compared to LV morphology and that children with cardiomyopathy did not have the expected survival benefit at therapeutic doses. Additionally, the Pediatric Heart Network (PHN) trial on the use of anti-converting enzyme inhibitors (ACE-I) in single ventricle anatomy, showed no difference in clinical outcomes comparing a treatment to a control group. Recent results from the PHN and the National Pediatric Cardiology Quality Improvement Collaborative (NPCQIC) showed observational data of a survival advantage for children with single ventricle anatomy who received digoxin between the Stage I Norwood and Stage II Glenn operations. We will discuss the current state of the evidence in pediatric heart failure & congenital heart disease, and its pharmacological & selected non-pharmacological therapeutic approaches.