Clinical Outcomes and Complications in Pediatric Ventricular Assist Devices Implanted as Bridge to Candidacy

Although the bridge-to-transplant (BTT) is the most common ventricular assist device (VAD) strategy, rapidly declining patients receive VADs as a "bridge to candidacy" (BTC) as their transplant candidacy is assessed. However, a lack of outcomes data for this group hinders informed decision-making and counseling. We compared outcomes between BTT and BTC cohorts in a retrospective analysis of the Advanced Cardiac Therapies Improving Outcomes Network registry of VADs implanted between January 2012 and August 2023. Of the patients studied, 383 (28.7%) underwent a BTC implant at a median age of 10.3 years and a median weight of 33.2 kg. The most common indications were dilated cardiomyopathy/myocarditis (51.6%) and congenital heart disease (38.0%). Nearly one-third (29.3%) were on ECMO at the time of implant. Major bleeding, renal dysfunction, and respiratory failure were significantly more common among BTC patients (p = 0.001-0.03). Bridge to candidacy candidates died more frequently on the device (21.9% vs. 9.7%, p < 0.001) and underwent successful transplantation less often (75% BTT vs. 50.4% BTC, p < 0.001). In conclusion, BTC VAD patients have higher rates of major adverse events and death. These data will assist in counseling and clinical decision-making for these patients.