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Pre-transplant VAD support shows no survival benefit but increases stroke risk in pediatric heart transplant recipientsPre-transplant VAD support does not improve long-term survival for pediatric heart transplant patients

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Key Takeaway
Note higher stroke risk with pre-transplant VAD support despite neutral survival benefit in pediatric heart transplant.

This systematic review and meta-analysis examined the impact of pre-transplant ventricular assist device support compared to no support in pediatric heart transplant recipients. The analysis included five studies where 3247 studies were identified for the search. The primary outcome assessed was long-term survival, while secondary outcomes included postoperative stroke, hospital length of stay, and post-transplantation rejection.

Regarding long-term survival, there was no significant difference between groups. The hazard ratio was 0.963 with a 95% CI of 0.84 to 1.10 and a p-value of 0.582. For hospital length of stay, no significant differences were observed with a standardized mean difference of -0.09 and a p-value of 0.4375.

However, the risk of postoperative stroke was significantly higher in the VAD group. The odds ratio was 2.17 with a 95% CI of 1.63 to 2.89 and a p-value less than 0.0001. Post-transplantation rejection also showed no significant differences with an odds ratio of 1.18 and a p-value of 0.0505. Safety concerns included higher VAD-related complications, particularly stroke.

Children waiting for a new heart often face long waits. Some doctors use a temporary heart pump called a VAD to keep them alive. A large review looked at five studies involving 3,247 identified cases to see if this pump helps kids survive longer after getting the new organ. The answer was no. Using the pump before the transplant did not change long-term survival rates compared to children who waited without one. The risk of dying remained the same for both groups.

However, there is a serious trade-off. Children who used the pump before the transplant faced a much higher risk of having a stroke after the surgery. The odds of a stroke were more than double for those who used the device. This is a significant safety concern that families and doctors must weigh carefully.

Other outcomes showed mixed results. The length of time spent in the hospital did not differ between the two groups. The risk of the new heart being rejected by the body also showed no significant difference. While the pump does not extend life, it does add a specific danger of stroke that requires careful consideration.

What this means for you:
Pre-transplant VAD support does not improve survival but increases stroke risk in children.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
OBJECTIVES: Heart transplantation is the gold standard therapy for pediatric end-stage heart failure. Ventricular assist devices (VADs) have improved waitlist survival, but their effect on post-transplant outcomes remains uncertain. This study aimed to evaluate the impact of pre-transplant VAD support on outcomes in pediatric heart transplant recipients. METHODS: We performed a systematic review and a meta-analysis using three different databases to compare outcomes in pediatric heart transplant recipients with and without pre-transplant VAD support. The primary outcome was long-term survival. Secondary outcomes were postoperative stroke, hospital length of stay (LOS), and post-transplantation rejection. RESULTS: A total of 3247 studies were identified, of which five were included in the analysis. There was no significant difference in long-term survival among patients who survived to transplantation between the groups (HR 0.963; 95% CI 0.84 to 1.10; p = 0.582). However, the postoperative stroke rate was significantly higher in the VAD group (OR 2.17; 95% CI 1.63 to 2.89; p < 0.0001), while no significant differences were observed in hospital LOS (SMD -0.09; 95% CI -0.33 to 0.14; p = 0.4375) or post-transplant rejection (OR 1.18; 95% CI 1.00 to 1.39; p = 0.0505). CONCLUSIONS: Pre-transplant VAD support was associated with non-inferior survival despite greater baseline severity among patients who survived to transplantation, enabling access to transplantation, but at the cost of higher VAD-related complications, particularly stroke, with no differences in hospital LOS or rejection.
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