Pediatric intracorporeal LVAD support in the transition from HVAD to HeartMate 3

Background: The withdrawal of the HeartWare HVAD required pediatric mechanical circulatory support programs to transition to alternative durable intracorporeal devices. We evaluated our single-center experience across the HVAD and HeartMate 3 (HM3) eras. Methods: We retrospectively reviewed all pediatric patients who underwent primary durable intracorporeal LVAD implantation between January 2012 and December 2024. Clinical characteristics, perioperative outcomes, survival on support, bridge-to-transplantation, and device-related adverse events were compared. Results: Thirty-four patients were included: 22 received HVAD and 12 received HM3. Baseline characteristics were generally comparable. Cardiopulmonary bypass time was significantly longer in the HM3 group ( p < 0.001). Median support duration was longer with HVAD (1002 vs 838 days; p = 0.304). Survival on LVAD support did not differ between groups (log-rank p = 0.375). Pump thrombosis (40.9% vs 0%; p = 0.013) and ischemic stroke (27.3% vs 0%; p = 0.069) occurred only in HVAD recipients, whereas infectious complications were comparable between groups. Conclusions: HM3 appears to be a feasible intracorporeal long-term support option for selected pediatric patients in the post-HVAD era. Longer-term multicenter pediatric studies are needed to define durability, late complications, and optimal patient selection.