Against all odds: Mechanical circulatory support as a bridge to pediatric heart transplant

Two pediatric patients with dilated cardiomyopathy and end-stage heart failure (ESHF) were bridged with extracorporeal devices to heart transplant (HTx).A 6-year-old boy received veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support with left ventricular unloading via subclavian drainage and later conversion to a hybrid configuration involving left and right ventricular assist devices (LVAD and RVAD) for 8 days. After HTx, acute kidney injury and hemorrhagic stroke occurred.A 12-year-old girl with recurrent cardiac arrests underwent emergency LVAD implantation (EXCOR® Active) for 6 h for bridging to HTx. She received 4 days of V-A ECMO support due to early primary graft dysfunction (PGD) and 9 days of continuous renal replacement therapy. Both children recovered with favorable outcomes.These patients demonstrate that bridging to HTx in ESHF is feasible even under resource-limited wartime conditions. Adaptability in ECMO and the unloading configuration can overcome severe logistical and technological limitations.