Safety and efficacy of short-term ventricular assist devices in paediatric heart transplant candidates: a systematic review and single arm meta-analysis

Safety and efficacy of short-term ventricular assist devices (VAD) remains incompletely understood, particularly in younger children. This systematic review and meta-analysis aims to evaluate outcomes, including bridging success, complications, and mortality, associated with short-term VAD support in paediatric heart transplant candidates. A systematic search of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from inception to 2 December 2024. Eligible studies reported patients ≤ 18 years supported by short-term VADs. This review was registered in PROSPERO (ID: CRD42023468125). Twelve retrospective studies met the inclusion criteria, encompassing 532 paediatric patients (mean age 10.0 years, < 0.1–18.3, mean weight 39.5 ± 30.3 kg). Pooled proportions show that with a mean support duration of 15.2 days, 50.7% were successfully bridged to transplant (95% CI 36.4%, 65.0%; I2 = 91.1%) with a 24.8% waitlist mortality (95% CI 17.6%, 31.9%; I2 = 63.8%), 14.0% (95% CI 7.2%, 20.9%; I2 = 97.5%) weaned off support and 5.4% (95% CI 2.6%, 8.3%; I2 = 39.1%) remaining on support. Complication rates were high with haemorrhage (38.9%), renal impairment (35.2%), cerebrovascular events (29.5%), infection (17.8%), and thromboembolism (9.9%) being the most reported. Short-term VADs offer a feasible bridge to transplant in paediatric patients, with success rates comparable to registry data. However, high rates of serious complications and waitlist mortality persist, particularly in these younger children. These findings demonstrate the need for improved patient selection, standardized outcome reporting, and development of safer, size-appropriate devices for paediatric use.