Thirteen years of continuous LVAD support: An extraordinary bridge to heart transplantation from childhood to adulthood.

Abstract

Pediatric heart failure remains a significant cause of morbidity, and orthotopic heart transplantation (OHT) is the gold-standard treatment for end-stage disease. Although mechanical circulatory support (MCS) is a well-established bridge-to-transplant strategy, reports of continuous support extending from early childhood into adulthood are exceedingly rare. We present a case of 13 years of uninterrupted left ventricular assist device (LVAD) support in a pediatric patient successfully bridged to transplantation. An 8-year-old girl (25 kg, 135 cm) with refractory dilated cardiomyopathy (left ventricular ejection fraction, 20%) underwent implantation of a continuous-flow intracorporeal LVAD (HeartWare ventricular assist device) in 2012. During an extraordinary 13-year (approximately 4.745-day) support period, the patient progressed through puberty and completed high school. Her clinical cour se included 24 episodes of driveline infection, two transient ischemic attacks, and two episodes of pump thrombosis, all of which were successfully managed medically without device exchange. At 21 years of age, following surgery for a ruptured endometrioma, a suitable donor heart became available. OHT was performed successfully. Despite an early episode of acute cellular rejection (Grade 2R) and cytomegalovirus reactivation, the patient remained clinically stable with preserved graft function at 1-year posttransplant. This case represents one of the longest documented durations of continuous LVAD support reported in the pediatric literature. It demonstrates the remarkable durability of contemporary MCS and highlights the feasibility of managing long-term complications through a multidisciplinary approach. This "extreme outlier" challenges the traditional bridge-to-transplant paradigm and suggests that ventricular assist devices may serve as a "bridge to life" during the critical transition fr om childhood to adulthood when donor availability is limited.