Amongst children on VAD >6 months, most undergo transplant; however, 20.3% remain on support at 2 years, with adverse events including infection (27%), device malfunction or pump thrombosis (13.6%), and stroke (4.9%).
One in 5 children with a ventricular assist device remains on the device for more than 6 months.
Children supported on VAD for longer than 6 months were significantly older than those supported 6 months or less.
Children with longer-term VAD support had a higher frequency of cardiomyopathy and implantable continuous devices compared to shorter-term patients.
At 2 years from implant, the majority of longer-term VAD patients were transplanted, but a substantial proportion remained on device support.
Several preimplant factors were associated with significantly increased mortality risk in longer-term VAD patients.
Adverse events were common among children on longer-term VAD support.
This research examined what happens to children who stay on a heart pump (ventricular assist device, or VAD) for a long time—more than 6 months. Using a large national registry of over 1,100 children, the researchers found that about 1 in 5 children with a VAD ended up in this longer-term support group. These children tended to be older and more likely to have a type of heart muscle disease called cardiomyopathy. By two years after getting the device, about 65% had received a heart transplant, 9% had died, and about 20% were still alive and waiting on the device. The study also identified factors that increased the risk of dying while on the device, including having had cancer, being on dialysis, having fluid buildup in the abdomen (ascites), and using a certain type of external (non-implantable) device. Serious complications were also common: more than 1 in 4 patients developed an infection, about 1 in 7 experienced a device problem or clot in the pump, and about 1 in 20 had a stroke. This research suggests that while most children who remain on a VAD for longer than 6 months eventually receive a transplant, a meaningful number continue on the device for years, and many experience significant complications during that time. The authors note that more research is needed to understand the quality of life and longer-term health outcomes for these children, as the data currently available are limited.
Mejia E, Koehl D, Cantor R, Kirklin J, Morales D, Perry T, et al.. (2026). Longer-Term Ventricular Assist Devices in Children: 10-Year Retrospective Analysis of Society of Thoracic Surgeons' PEDIMACS.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.044494