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Comparing Outcomes of Heartmate 3 and Heart Transplantation in Older Children With Dilated Cardiomyopathy-Can

Waldemar F Carlo1, Luz A Padilla2, James K Kirklin3

  • 1Department of Pediatrics, University of Alabama, Birmingham, USA.

Pediatric Transplantation
|June 23, 2026
PubMed

Insights

Adolescents with dilated cardiomyopathy (DCM) showed excellent survival with Heartmate 3 (HM3) or heart transplant. Many HM3 patients were transplanted early, suggesting HM3 can support patients while awaiting transplant.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Medical Devices

Background:

  • End-stage dilated cardiomyopathy (DCM) in children typically requires heart transplantation or temporary ventricular assist devices.
  • Limited pediatric data exists for the Heartmate 3 (HM3) device as a longer-term option for DCM.
  • This study compares HM3 and heart transplantation outcomes in adolescents with DCM.

Purpose of the Study:

  • To evaluate the survival and adverse event rates of adolescents (ages 10-18) with DCM treated with HM3 versus heart transplantation.
  • To assess the feasibility of using HM3 as a longer-term support or bridge to transplant in this population.

Main Methods:

  • Analysis of two clinical registries: Pedimacs and Pediatric Heart Transplant Society.
  • Inclusion criteria: DCM patients aged 10-18 years, treated with HM3 or transplant between 2017-2022.
  • Data collected on mortality and adverse events.

Main Results:

  • Ninety HM3 patients and 306 transplant patients were analyzed.
  • Similar 12- and 36-month survival rates: 94.4% for HM3 and 99.3%/95.6% for transplant.
  • HM3 cohort had a higher proportion of Black patients (40% vs. 30%).
  • Sixty-six HM3 patients (73%) were transplanted early (median 2.8 months); 3 late explants for recovery, 3 early deaths.
  • Low rates of bleeding, stroke, and device malfunction (<0.1 events/patient/year) in the HM3 group.

Conclusions:

  • Adolescents with DCM treated with HM3 or transplant demonstrated excellent 3-year outcomes.
  • Early transplantation was common for HM3 patients, indicating HM3's role in supporting patients awaiting transplant.
  • HM3 offers potential for delaying or avoiding transplantation, improving long-term survival, and preserving donor organs.
Abstract

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