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Updated: Aug 1, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
The waiting game: bridging to paediatric heart transplantation
Allan P Goldman1, Jane Cassidy, Marc de Leval
1Great Ormond Street Children's Hospital, Great Ormond Street, WC1N 3JY, London, UK. goldma1@gosh.nhs.uk
Insights
Mechanical assist devices can help children with end-stage cardiomyopathy survive heart transplantation. Extracorporeal membrane oxygenation offers the safest support, minimizing deaths on the transplant waiting list.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Mechanical circulatory support (MCS) is crucial for adults awaiting organ transplantation.
- The efficacy of MCS in bridging pediatric patients with end-stage cardiomyopathy to heart transplantation requires specific evaluation due to organ donor limitations.
Purpose of the Study:
- To assess the impact of mechanical assist devices in bridging pediatric patients with end-stage cardiomyopathy to heart transplantation.
- To evaluate survival rates and waiting times for pediatric heart transplantation using MCS.
Main Methods:
- Retrospective review of the UK pediatric transplant program data.
- Analysis of data from two UK pediatric transplant centers between January 1, 1998, and December 31, 2002.
- Inclusion of 22 children with end-stage cardiomyopathy supported by mechanical assist devices.
Main Results:
- A 77% survival rate to hospital discharge was observed in children bridged to heart transplantation.
- Extracorporeal membrane oxygenation (ECMO) showed a 92% survival rate to discharge in 13 patients.
- Paracorporeal ventricular assist device (PVAD) support resulted in a 55% survival rate to discharge in 9 patients.
- A significant negative correlation (r=-0.93, p=0.02) was found between bridging to transplantation and waiting list mortality.
Conclusions:
- A national mechanical assist program can effectively minimize deaths among children on the heart transplant waiting list.
- Extracorporeal membrane oxygenation appears to be the safest mechanical support option for pediatric heart transplantation.
- Urgent listing and short waiting times are critical for successful bridging to transplantation in pediatric patients.
Background:
Although mechanical circulatory support might not increase the number of adults surviving to transplantation, because of the shortage of donor organs, the situation might be different for children. Our aim was to assess the effect of mechanical assist devices to bridge children with end-stage cardiomyopathy to heart transplantation.
Methods:
A 5-year retrospective review was undertaken with data from the UK paediatric transplant programme and from bridging to transplant done at two paediatric transplant centres in the UK.
Findings:
Between Jan 1, 1998 and Dec 31, 2002, 22 children with end-stage cardiomyopathy, median age 5.7 years (range 1.2-17), were supported by a mechanical assist device as a bridge to first heart transplantation, with a 77% survival rate to hospital discharge. Nine were supported by a paracorporeal ventricular assist device, six received transplantation, five survived to discharge (55%), with one late death. 13 were supported by extra-corporeal membrane oxygenation, and 12 were transplanted and survived to discharge (92%) with one late death. With urgent listing, the median waiting time for a heart was 7.5 days (range 1.5-22 days). The correlation between the proportion of patients bridged to transplantation and the proportion of patients dying while on the transplant waiting list was r=-0.93, p=0.02.
Interpretation:
Our findings lend support to the hypothesis that a national mechanical assist programme to bridge children to transplantation can minimise the number dying while on the heart transplant waiting list. In the context of urgent listing and a short waiting time, extra-corporeal membrane oxygenation seems to provide the safest form of support.
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