Mechanical Circulatory Support as a Bridge to Pediatric Heart Transplantation: A 36-Year Single-Center Experience

All articles of this category (opens in new window) Background: Despite advances in mechanical circulatory support (MCS) for pediatric patients, its use remains complex and is associated with significant perioperative and postoperative challenges, particularly in critically ill individuals. We conducted a retrospective analysis to compare outcomes between patients who received MCS prior to heart transplantation (HTx) and those who did not. Methods: We reviewed records of all pediatric patients who underwent HTx at our center between 1988 and 2024. Comparative analyses were performed between patients with pre-HTx MCS and MCS-naïve patients, including baseline characteristics, perioperative outcomes, and long-term survival. Results: Of 278 pediatric heart transplants performed, 38 (14%) recipients had pre-HTx MCS. MCS patients were significantly older, with 87% being older than 1 year at the time of transplant. Cardiomyopathy was more common among MCS patients compared with congenital heart disease (76% vs. 24%, p < 0.001). Waitlist times did not differ significantly between groups. During transplantation, median cardiopulmonary bypass time was longer in the MCS group (300 vs. 252 minutes, p = 0.05). Postoperatively, 30-day mortality was comparable between groups. However, postoperative hemodialysis was significantly more frequent in MCS patients (29% vs. 13.4%, p = 0.040). Long-term survival was similar, with 20-year Kaplan–Meier estimates of 70.0% for MCS patients and 70.2% for MCS-naïve patients ( p = 0.67). Conclusion: Pretransplant MCS is associated with longer operative times and a higher incidence of postoperative hemodialysis, but does not adversely affect early or long-term survival following heart transplantation. These findings support the safe and effective use of MCS as a bridge to transplantation in pediatric patients. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany