Three Decades of Paediatric Heart Transplantation: Long-term Outcomes and the Evolving Role of Mechanical Circulatory Support

Heart transplantation (HTx) remains the definitive therapy for children with end-stage heart failure, while donor scarcity exposes candidates to deterioration during waiting. Mechanical circulatory support (MCS), particularly ventricular assist devices (VADs), has therefore become an increasingly important bridge to transplantation.1–5 We report the long-term experience of a single high-volume congenital heart centre over more than 3 decades, focusing on temporal changes in paediatric HTx and the evolving role of pretransplant MCS. We retrospectively reviewed 267 patients transplanted at our institution between 1988 and 2024. The cohort was defined by transplantation within the paediatric/congenital programme. Clinical, operative and follow-up data were extracted from institutional records. Overall survival was assessed by Kaplan–Meier analysis. Mechanical circulatory support before HTx was retained as a clinical variable rather than used to define the primary study groups. Mechanical circulatory support included extracorporeal membrane oxygenation (ECMO) and VAD support. The study was approved by the Ethics Committee of Justus Liebig University Giessen (AZ 94/23; July 27, 2023).