Summary
Pediatric VAD before heart transplant improves survival on the waiting list. Whether it affects how children fare after transplant has been less clear.
Researchers linked records from the ACTION and Pediatric Heart Transplant Society (PHTS) registries, covering 1,360 children listed before age 18 and transplanted between April 2018 and June 2022. Of those, 405 were supported by a ventricular assist device and 955 were managed medically. Children in the device group were younger at transplant and more often on mechanical ventilation, while congenital heart disease was considerably more common in the medically managed group, 64.8% versus 35.1%.
Overall graft survival was similar between the two groups. In the initial analysis, two of the three device types appeared linked to graft loss, along with several measures of how sick patients were. Those device associations disappeared once the groups were matched on patient characteristics. Device support was also associated with a lower risk of infection after transplant. Among children on devices, those who experienced infection, bleeding, or respiratory failure while supported had worse outcomes afterward.
The authors conclude that the differences seen by device type likely reflect the complexity of those patients rather than an effect of the devices themselves.
This ACTION study was published on October 2, 2026 online in The Journal of heart and Lung Transplantation. Congratulations to the authors:
- Scott R. Auerbach
- Kristin Anton
- Neha Bansal
- Carmel Bogle
- Katerina Boucek
- Ryan S. Cantor
- James K. Kirklin
- David N. Rosenthal
- Muhammad Farrukh Shezad
- Simon Urschel
- Kae Watanabe
- Hong Zhao
- Matthew J. O’Connor
