IntroductionDonor shortage and organ allocation is the main problem in pediatric heart
transplant. Mechanical circulatory support is known to increase waiting list
survival, but it is not routinely used in pediatric programs in Latin
America.MethodsAll patients listed for heart transplant and supported by a mechanical
circulatory support between January 2012 and March 2016 were included in
this retrospective single-center study. The endpoints were mechanical
circulatory support time, complications, heart transplant survival and
discharge from the hospital.ResultsTwenty-nine patients from our waiting list were assessed. Twelve (45%)
patients were initially supported by extracorporeal membrane oxygenation
(ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five
patients initially supported by ECMO were bridged to another device. One was
bridged to a centrifugal pump and four were bridged to Berlin Heart
Excor®. Among the 29 supported patients, 18 (62%) managed to have a
heart transplant. Thirty-day survival period after heart transplant was 56%
(10 patients). Median support duration was 12 days (interquartile range
[IQR] 4 - 26 days) per run and the waiting time for heart transplant was 9.5
days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality
predictor (OR=22.6 [CI=1.04-494.6]; P=0.04).ConclusionMechanical circulatory support was able to bridge most INTERMACS 1 and 2
pediatric patients to transplant with an acceptable complication rate. Acute
renal failure increased mortality after mechanical circulatory support in
our experience.