Against all odds: Mechanical circulatory support as a bridge to pediatric heart transplant

Abstract

Two pediatric patients with dilated cardiomyopathy and end-stage heart failure (ESHF) were bridged with extracorporeal devices to heart transplant (HTx).

A 6-year-old boy received veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support with left ventricular unloading via subclavian drainage and later conversion to a hybrid configuration involving left and right ventricular assist devices (LVAD and RVAD) for 8 days. After HTx, acute kidney injury and hemorrhagic stroke occurred.

A 12-year-old girl with recurrent cardiac arrests underwent emergency LVAD implantation (EXCOR® Active) for 6 h for bridging to HTx. She received 4 days of V-A ECMO support due to early primary graft dysfunction (PGD) and 9 days of continuous renal replacement therapy. Both children recovered with favorable outcomes.

These patients demonstrate that bridging to HTx in ESHF is feasible even under resource-limited wartime conditions. Adaptability in ECMO and the unloading configuration can overcome severe logistical and technological limitations.

Keywords

continuous renal replacement therapy extracorporeal membrane oxygenation heart transplant primary graft dysfunction ventricular assist device

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