Early outcomes of pediatric heart transplantation: Impact of mechanical circulatory support and perioperative challenges. A single-center retrospective study

Muhammad Shahzad; Reem Beheri; Bushra Algethami; Yasser Alheraish; Dimpna Albert; Felix W Tsai; Zohair Alhalees; Khaled Alarwan

doi:10.62838/jccm-2026-0016

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Early outcomes of pediatric heart transplantation: Impact of mechanical circulatory support and perioperative challenges. A single-center retrospective study

The Journal of Critical Care Medicine

Volume 12 (2026): Issue 2 (April 2026)

By: Muhammad Shahzad, Reem Beheri, Bushra Algethami, Yasser Alheraish, Dimpna Albert, Felix W Tsai, Zohair Alhalees and Khaled Alarwan

Open Access

|Apr 2026

Abstract

Background

Pediatric heart transplantation stays the gold standard treatment for end-stage heart failure, but outcomes are influenced by pre-transplant status and bridging strategies, particularly mechanical circulatory support (MCS).

Objectives

To evaluate early outcomes following pediatric heart transplantation and assess the impact of pre-transplant MCS on survival and complications.

Methods

We retrospectively analyzed all pediatric patients (<14 years) who underwent orthotopic heart transplantation at a single tertiary center between January 2020 and January 2025. Demographics, pre-transplant support, intraoperative data, and early outcomes were collected. Primary outcome was 30-day survival; secondary outcomes included acute rejection, infection, acute kidney injury (AKI), neurologic complications, and ICU/hospital length of stay (LOS). Comparative analyses were performed between patients having ECMO- and ventricular assist devises (VAD) using Fisher's exact and Wilcoxon rank-sum tests. Kaplan–Meier survival estimates were generated.

Results

Thirty patients were transplanted (median age 9 years, 63.3% female). Most (96.7%) needed MCS, including 11 ECMO and 18 VAD. Thirty-day survival was 28/30 (93.5%, 95% CI 78–99). Acute rejection occurred in 3 (10%), infections in 4 (13.3%), AKI in 8 (26.7%), with two requiring CRRT, and neurologic complications in 3 (10.3%). Median ICU and hospital LOS were 20 and 37 days, respectively. ECMO patients had longer post-transplant ventilation (12 vs 6 days, p = 0.04) and ICU length of stay (LOS) compared to VAD patients. Total Ischemic time, and CPB times were associated with increased morbidity.

Conclusions

Early outcomes after pediatric heart transplantation prove high short-term survival but substantial morbidity. ECMO bridging was associated with greater resource use than VAD. Improving donor heart ischemic time, donor-recipient matching, perioperative management, and early initiation of durable MCS may further improve outcomes.

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Articles in this issue

DOI: https://doi.org/10.62838/jccm-2026-0016 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 291 - 299

Submitted on: Oct 21, 2025

Accepted on: Mar 11, 2026

Published on: Apr 30, 2026

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

pediatric heart failure,

treatment,

mechanical circulatory devices,

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2026 Muhammad Shahzad, Reem Beheri, Bushra Algethami, Yasser Alheraish, Dimpna Albert, Felix W Tsai, Zohair Alhalees, Khaled Alarwan, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 12 (2026): Issue 2 (April 2026)