Berlin Heart EXCOR as a Bridge to Transplantation in Pediatric End-Stage Heart Failure: A Retrospective Cohort Study

Background: Ventricular assist devices serve as a critical bridge to transplantation for pediatric patients with end-stage heart failure. This study evaluated the outcomes of pediatric patients who received Berlin Heart EXCOR support for end-stage heart failure. Methods: We retrospectively analyzed data from 11 consecutive pediatric patients (63.64% male, median age 60 months) who underwent Berlin Heart implantation from November 2021 to April 2025. The majority (90.90%) had dilated cardiomyopathy, and 72.73% were INTERMACS class I. Results: Of the 11 patients, 54.54% received an LVAD only, 36.36% received a BiVAD, and 9.09% required an LVAD followed by an RVAD. The postoperative mean ICU stay was 140 ± 73 days, and total hospital stay was 192 ± 96 days. Significant post-implant complications included stroke (27.27%), bleeding requiring exploration (27.27%), and pneumonia (36.36%). Ten patients (90.91%) were successfully bridged to heart transplantation, with one pre-transplant mortality (9.09%) due to brain hemorrhage. The median time to transplantation was 88 days (interquartile range, IQR: 78–177). During a median follow-up of 17 months (IQR: 7–32), two patients died post-transplant, resulting in an overall survival rate of 67.50% at 3 years. Conclusion: Despite significant complications and prolonged hospitalization, the Berlin Heart demonstrated effectiveness as a mechanical circulatory support device for pediatric patients, with a high rate of successful bridging to transplantation and acceptable mid-term survival. These findings support its use as a viable bridge to transplantation in pediatric end-stage heart failure.