Analysis of United Network for Organ Sharing: Berlin Heart as Bridge to Transplant in Patients Aged 5 and Under

The Berlin Heart paracorporeal ventricular assist device (VAD) is widely used for bridging pediatric patients to transplantation. Contemporary, multiinstitutional analyses of VAD types used in children and their impact on outcomes are limited. This analysis evaluates multiinstitutional outcomes after cardiac transplantation in patients aged ≤5 years in the following categories: no VAD, Berlin Heart VAD, or other VAD. The United Network for Organ Sharing database was analyzed to evaluate perioperative outcomes and 3-year survival in patients aged ≤5 years undergoing first-time cardiac transplantation (September 6, 2004 to June 30, 2023). The study population comprised 3649 patients (no VAD [n = 2822], Berlin Heart [n = 670], other VAD [n = 157]). Distinct demographic and clinical characteristics were observed among patients bridged with Berlin Heart, including a higher prevalence of congenital heart disease, longer waitlist durations, and higher utilization of extracorporeal membrane oxygenation at transplant. Patients bridged with other VADs exhibited notably higher 3-year mortality compared with both Berlin Heart and no VAD groups. Multivariable analysis identified key risk factors associated with increased mortality, including congenital heart disease and extracorporeal membrane oxygenation at transplant. By highlighting the comparative effectiveness of different VAD types and key risk factors, our study contributes valuable insights in guiding clinical decision-making in this challenging patient population and also provides important information to guide future research.