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Analysis of UNOS: Ventricular assist device as bridge-to-transplant in pediatric patients with congenital heart disease.

Ahmet Bilgili,J. Pendarvis,Omar M Sharaf,Giles J. Peek,M. Bleiweis,J. Jacobs

Published 2025 in European Journal of Cardio-Thoracic Surgery

ABSTRACT

OBJECTIVES In a multi-institutional contemporary cohort of patients < 18 years with congenital heart disease (CHD), we compare outcomes of bridge-to-transplant with and without ventricular assist device (VAD). METHODS UNOS was queried for all patients < 18 years with CHD listed for cardiac transplantation (1/1/2014-12/31/2023). Patients were split into two cohorts based on the presence of VAD while on the waitlist. Univariable and multivariable analysis was performed to assess baseline characteristics and post-transplant survival. RESULTS The overall patient cohort consisted of 3394 CHD patients listed for cardiac transplantation at 65 centers: 561/3394 = 16.5% had VAD support while on the waitlist and 2833/3394 = 83.5% did not. A total of 396/561 = 70.6% of VAD-supported patients and 1852/2833 = 65.4% of nonVAD-supported patients underwent cardiac transplantation.Waitlist mortality, defined as death or removal from waitlist due to clinical deterioration, was 602/3394 = 17.7% for all patients, 144/561 = 25.7% for VAD-supported patients, and 458/2833 = 16.2% for nonVAD-supported patients.Amongst the 2248 transplanted CHD patients transplanted at 65 centers (n = 396 VAD-supported, n = 1852 nonVAD-supported), Berlin Heart was the most frequently used VAD (209/396 = 52.8%), and VAD configuration was mostly LVAD (306/396 = 77.3%). VAD-support amongst CHD patients < 18 bridged-to-transplant increased (20 in 2014, 73 in 2023). VAD-supported patients had similar rates of post-transplant stroke (25/389 = 6.4% versus 83/1835 = 4.5%,p = 0.145) and episodes of acute rejection (60/396 = 15.2% versus 305/1852 = 16.5%,p = 0.582) compared to nonVAD-supported patients. No significant differences between VAD-supported and nonVAD-supported patients were seen in longitudinal post-transplant survival up to 5 years(log-rank p = 0.257). CONCLUSIONS In the last decade, patients < 18 years with CHD bridged-to transplant with VAD achieve post-transplant outcomes and long-term survival similar to those bridged without VAD.

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