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J Am Coll Cardiol. 2018 Jul 24;72(4):402-415. doi: 10.1016/j.jacc.2018.04.072.

Ventricular Assist Device Support as a Bridge to Transplantation in Pediatric Patients.

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Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatrics, Children's Health System of Texas, Dallas, Texas.
Department of Pediatrics, Stanford University, Palo Alto, California.
Division of Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado.
Department of Pediatrics, Morgan Stanley Children's Hospital-Columbia University Medical Center, New York, New York.
Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.



Pediatric ventricular assist device (VAD) use has evolved dramatically over the last 2 decades.


This study sought to describe the evolution of VAD support to heart transplantation (HTx) in children in a large international multicenter cohort.


Using data from the Pediatric Heart Transplant Study, comparisons were made between children (<18 years) supported to HTx (January 1, 1993 to December 31, 2015) with VAD or extracorporeal membrane oxygenation (ECMO) to VAD support.


Of 7,135 listed patients, 5,145 underwent HTx; 995 (19.3%) were supported by a VAD (113 with congenital heart disease [CHD]). Patients with a VAD as their first device (n = 821) were older, larger, and more likely to have cardiomyopathy (80%) than patients transitioned from ECMO to VAD (n = 164). In the VAD-only cohort, 79% underwent HTx and 14% died, compared with 69% and 24% in the ECMO-to-VAD cohort, respectively. Patients with cardiomyopathy achieved HTx 84% of the time, with a 9% waitlist mortality rate compared with 55% and 36%, respectively, for CHD. Among VAD-treated patients, 79% were age >10 years in the earliest era, a percentage decreasing to 34% more recently, though neonates still represent <1%. Overall, survival at 2 and 20 years showed no difference between VAD and no support (2 years: 75% vs. 80%; 20 years: 55% vs. 54%). Post-HTx outcomes were better for durable versus temporary VADs (p < 0.01) and for continuous versus pulsatile VADs (p < 0.01) from 2005 onward; timing of VAD had no impact on post-HTx survival (p = 0.65).


For one-quarter of a century, major advances have occurred in mechanical support technology for children, thereby expanding the capability to bridge to HTx without compromising post-HTx outcomes. Significant challenges remain, especially for neonates and patients with CHD, but ongoing innovation portends improved methods of support during the next decade.


durable; extracorporeal membrane oxygenation; heart failure; outcomes; survival

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