Early Hazard, Late Convergence: Waitlist Ventricular Assist Device Timing and Survival After Pediatric Heart Transplantation

Authors

• Raisa Razalan-Clarey, Pediatric Cardiology Fellow - Corewell Health West
• Asmita Sharma, Pediatric Cardiology Fellow - Corewell Health West
• Rohit Ganduboina
• Osama Eltayeb, Pediatric Cardiothoracic Surgery - Corewell Health West
• Marcus Haw, Pediatric Cardiothoracic Surgery - Corewell Health West
• Jean Ballweg, Pediatric Cardiac Transplant - Corewell Health West
• Sandeep Sainathan, Pediatric Cardiothoracic Surgery - Corewell Health West

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2025

Abstract

Pediatric patients with end-stage heart failure frequently require ventricular assist devices (VADs) as a bridge to heart transplantation. While VAD support at listing is common, a substantial subset of patients deteriorate and require VAD implantation after waitlisting. We examined whether the timing of VAD implantation on the waitlist influences early and long-term post-transplant survival.

Using the UNOS database (2003-2025), we identified pediatric heart transplant recipients who required VAD support prior to transplantation. Patients were stratified into two groups: Existing VAD at listing and After-listing VAD implantation. Recipient, donor, waitlist, and transplant characteristics were compared. Post-transplant survival was assessed using standardized statistical tests.

Among 12,983 pediatric heart transplant recipients, 2,288 (17.6%) received mechanical circulatory support prior to transplantation, including 1,278 (55.9%) with a ventricular assist device (VAD) at listing and 1,010 (44.1%) who required VAD implantation after waitlisting. Patients receiving VAD after waitlisting were younger and experienced longer waitlist durations compared with those with an existing VAD at listing. The after-listing VAD group demonstrated greater clinical acuity, with higher rates of blood transfusion, mechanical ventilation, and intravenous inotrope use. Time-varying hazard ratio analysis confirmed a marked early excess mortality risk in the after-listing VAD group that attenuated over time and approached unity beyond two years post-transplant.

Among pediatric heart transplant recipients requiring VAD support, implantation after waitlisting is associated with significantly higher early post-transplant mortality, but does not adversely impact long-term survival.

Recommended Citation

Razalan-Clarey R, Sharma A, Ganduboina R, Eltayeb O, Haw M, Ballweg J, Sainathan S. Early hazard, late convergence: Waitlist ventricular assist device timing and survival after pediatric heart transplantation. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2124