One-year follow-up of pediatric LVAD implantation vs heart transplantation: a pilot observational study

Background Heart transplantation (HTx) is regarded as the definitive therapy for advanced heart failure. Scarcity of donor organs has necessitated the use of mechanical circulatory support. Data exploring mid-term clinical outcomes between pediatric patients undergoing HTx and left ventricular assist devices (LVADs) remain limited. Methods This two-center retrospective pilot study included pediatric patients between June 2023 and November 2025. Patients were divided into two groups: the LVAD group and the pediatric HTx (PHT) group. Pre-procedural data were collected. At the one-year follow-up, clinical outcomes, functional status, and laboratory parameters were reassessed. Continuous variables were compared using the Mann–Whitney U test, and categorical variables were analyzed using Fisher’s exact test. Between-group differences were estimated using the Hodges–Lehmann median difference with corresponding 95% confidence intervals. Results During the study period, 22 patients were included, with 11 in the LVAD group and 11 in the PHT group. At one-year follow-up, mortality was similar, with one death occurring in each group. Among the surviving patients, two patients got respiratory infection in LVAD group and one in PHT group had an acute rejection during the follow-up period. The three patients got unplanned readmission. No other adverse events were observed during the whole follow-up. Conclusion In this small retrospective two-center pilot cohort, one-year mortality was numerically similar between children treated with LVAD implantation and heart transplantation. These exploratory findings support the feasibility of further comparative studies but should not be interpreted as evidence of equivalent outcomes between LVAD and transplantation.