Abstract
INTRODUCTION: Heart failure in paediatric patients is a complex and challenging condition. While heart transplantation is the gold standard for treating end-stage heart failure, limited donor availability necessitates alternative therapies, such as ventricular assist devices (VADs). The HeartMate 3 (HM3) VAD use in adults is well-established, but there is less data regarding outcomes in children. This study aims to evaluate the short-term outcomes of the first paediatric HM3 VAD programme in Saudi Arabia. METHODS: We conducted a retrospective cohort study involving 15 consecutive paediatric patients treated with HM3 at a single tertiary cardiac centre from 2022 to 2024. Postoperative outcomes included stroke, device thrombosis, driveline infection, hospital mortality, follow-up survival and time to transplantation. RESULTS: The cohort had a mean age of 11.07 years, with a predominance of females (67%). Average body surface area was 1.2 m2 (range 0.85-1.76 m2). The most frequent diagnosis was dilated cardiomyopathy (n = 13, 87%). The median lengths of ICU and hospital stays were 42 days and 56 days, respectively. The complications included strokes (n = 2, 13%), re-exploration for bleeding (n = 1, 7%), driveline infection (n = 2, 14%) and device thrombosis (n = 1, 7%). In-hospital mortality occurred in two patients. The median follow-up period was 17 months, and 60% (n = 9) of patients underwent successful transplantation. No mortality was reported beyond hospital discharge, and the overall 1-year survival was 87%. The 1-year transplantation-free survival rate was 55%. CONCLUSION: HM3 LVADs have favourable safety profiles and survival outcomes in paediatric patients with end-stage heart failure. These findings support HM3's as a viable option for managing advanced heart failure in the Saudi paediatric population, with further studies warranted to assess long-term outcomes.