Antiangiotide

We evaluated the national outcomes of all pediatric patients bridged-to-transplant with the HeartMate 3 (HM3) and compared the outcomes of those with congenital (CHD) versus acquired (AHD) heart disease.

The United Network for Organ Sharing (UNOS) database was queried for all patients <18 years in the United States ever supported with HM3 and entered into UNOS up to December 2024. Univariable analyses were performed to assess baseline characteristics and post-transplant survival.

A total of 254 patients <18 years in UNOS have been supported with HM3 in the United States and entered into UNOS up to December 2024, including 230/254=90.6% successfully bridged-to-transplant with HM3, 10/254=3.9% transplanted without HM3, and 14/245=5.5% not transplanted and removed from the waiting list. Overall waitlist mortality was 12/254=4.7%. Median age and weight were 14.0 years(IQR=12.0-16.0,range=7.0-17.0) and 56.9 kg(IQR=43.3-75.0,range=16.5-141.0), respectively. Median duration of support was 83.0 days(IQR=35.0-184.0). LVAD was the predominant VAD configuration(206/230=89.6%) followed by BiVAD(20/230=8.7%) and RVAD(4/230=1.7%). Post-transplant rates of dialysis(17/230=7.4%) and stroke(8/230=3.5%) were low across the cohort. Aggregate 1-year post-transplant mortality was 7/230=3.0%, with survival estimates of 96.6% at 1-year(95%CI=94.1%-99.1%), and 85.8% at 5-years(95%CI=78.6%-93.6%). CHD patients had longer durations of HM3 support compared to AHD patients (141 days[IQR=59.0-235.0] versus 76.0 days[IQR=33.0-167.0],p=0.013). No difference was observed between CHD and AHD in 1-year post-transplant mortality (1/39=2.6% and 6/191=3.1%, respectively, p=0.999) nor in 3-years post-transplant survival (90.6%[95%CI=78.2%-99.9%] in CHD and 90.1%[95%CI=84.9%-95.5%], respectively, p=0.828).

HM3 is an effective bridge-to-transplant in larger pediatric patients, with equivalent long-term outcomes between CHD and AHD.