The Impact of Pre‐Transplant Ventricular Assist Device Support on Survival After Heart Transplantation in Pediatric Patients: A Systematic Review and Meta‐Analysis of Reconstructed Time‐To‐Event Data

ABSTRACT Objectives Heart transplantation is the gold standard therapy for pediatric end‐stage heart failure. Ventricular assist devices (VADs) have improved waitlist survival, but their effect on post‐transplant outcomes remains uncertain. This study aimed to evaluate the impact of pre‐transplant VAD support on outcomes in pediatric heart transplant recipients. Methods We performed a systematic review and a meta‐analysis using three different databases to compare outcomes in pediatric heart transplant recipients with and without pre‐transplant VAD support. The primary outcome was long‐term survival. Secondary outcomes were postoperative stroke, hospital length of stay (LOS), and post‐transplantation rejection. Results A total of 3247 studies were identified, of which five were included in the analysis. There was no significant difference in long‐term survival among patients who survived to transplantation between the groups (HR 0.963; 95% CI 0.84 to 1.10; p = 0.582). However, the postoperative stroke rate was significantly higher in the VAD group (OR 2.17; 95% CI 1.63 to 2.89; p < 0.0001), while no significant differences were observed in hospital LOS (SMD −0.09; 95% CI −0.33 to 0.14; p = 0.4375) or post‐transplant rejection (OR 1.18; 95% CI 1.00 to 1.39; p = 0.0505). Conclusions Pre‐transplant VAD support was associated with non‐inferior survival despite greater baseline severity among patients who survived to transplantation, enabling access to transplantation, but at the cost of higher VAD‐related complications, particularly stroke, with no differences in hospital LOS or rejection.