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Published on: April 17, 2021
[Long-term mechanical circulatory support in childhood in Hungary]
Csaba Vilmányi1, S György Reusz2,3, Gábor Fésüs1
11 Gottsegen György Országos Kardiovaszkuláris Intézet, Gyermekszív Központ Budapest Magyarország.
Insights
Mechanical circulatory support (MCS) in pediatric heart failure is effective, enabling transplantation. Continuous-flow devices offer lower complication rates and better outcomes compared to pulsatile devices.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Introduction:
Mechanical circulatory support devices play a key role in stabilizing patients with end-stage heart failure and preparing them for heart transplantation. These devices significantly reduce waitlist mortality, especially in the pediatric population, where donor shortage and treatment challenges pose major difficulties.
Objective:
The aim of our study was to summarize domestic experiences with long-term mechanical circulatory support in pediatric patients and compare our outcomes with international data.
Method:
We retrospectively analyzed data from 27 pediatric patients implanted with ventricular assist devices between 2008 and 2025. The patients were categorized into pulsatile and continuous-flow device groups. Anthropometric data, clinical status (INTERMACS profiles), organ perfusion, perioperative parameters, and long-term outcomes were evaluated.
Results:
The mean age of the 27 children was 9.14 years, with an average weight of 36.6 kg and an average height of 130 cm. The average duration of mechanical support was 217 days, significantly shorter in the pulsatile group compared to the continuous-flow group (141 vs. 312 days, p = 0.009). The pulsatile group consisted of younger and smaller patients (5.3 vs. 13.9 years, p<0,001; 21 vs. 56 kg, p<0.001). More than 70% of the patients were successfully bridged to transplantation, with rates of 66% in the pulsatile and 83% in the continuous-flow groups. Continuous-flow devices were associated with fewer complications (33% vs. 60%), and less need for intensive care ventilatory support (6 vs. 20 days). No significant differences were found in organ perfusion and immunological sensitization between the groups. Post-transplant rejection rates were low and similar in both groups.
Discussion:
Mechanical circulatory support represents a significant advancement in the care for advanced heart failure children. Continuous-flow devices show a more favorable complication profile. However, significant risks remain in lower-weight patients (e.g., under 1 year of age), reflecting current technological and protocol limitations.
Conclusion:
The domestic use of mechanical circulatory support in pediatric patients is effective and enables successful transplantation. Continuous-flow devices offer advantages due to lower complication rates and feasibility of outpatient care. Larger prospective studies are needed to further improve outcomes. Orv Hetil. 2026; 167(1): 30-36.
