A Single-Center Real-World Experience: Early and Long-Term Outcomes of Pediatric Heart Transplantation with or Without a Left Ventricular Assist Device Bridging

<b>Background</b>: Pediatric heart transplantation (HTx) is the standard therapy for end-stage heart failure in children, and the use of durable left ventricular assist devices (LVADs) as a bridge to transplant is increasing. However, comparative long-term data for LVAD-bridged versus directly transplanted pediatric recipients remain limited. In this study, we aimed to compare the early and long-term outcomes of pediatric heart transplantation with and without LVAD bridging. <b>Methods</b>: We retrospectively reviewed all pediatric patients who underwent orthotopic HTx at our institution between 2004 and 2024. 34 recipients were included, 17 bridged with durable LVAD support, and 17 transplanted without mechanical circulatory support. Perioperative characteristics, early postoperative complications, and long-term outcomes were compared between groups. <b>Results</b>: LVAD recipients had more advanced ventricular dysfunction, longer cardiopulmonary bypass and aortic cross-clamp times, and more frequent red blood cell transfusion requirements. Despite this higher-risk profile, early postoperative complications, early mortality, and ICU and hospital length of stay were similar between groups. Ten-year survival was 70.6% in the LVAD group, and 82.4% in the non-LVAD group (log-rank <i>p</i> = 0.365), and freedom from CAV and treated rejection did not differ significantly. <b>Conclusions</b>: In this single-center, two-decade experience, durable LVAD support enabled successful transplantation of high-risk pediatric candidates without compromising early or long-term post-transplant outcomes. LVAD bridging appears to be a safe and effective strategy in pediatric HTx.