Open Access

ARTICLE

Preoperative ECMO Bridging in Pediatric Heart Transplantation: A Cohort Study on Graft Remodeling, Inflammatory Biomarkers and Survival

Hui Yi^1,2,#, Hongjian Shi^2,3,#, Fuquan Kan^2,4,#, Fan Han², Lei Wan⁵, Xiaoyang Hong¹, Zhe Zhao¹, Junjie Shao², Gang Wang¹, Hui Wang¹, Hua Yan⁵, Xiujuan Shi¹, Ran Zhang^2,6,*, Gengxu Zhou^1,*

1 Division of Pediatric Cardiology, Department of Pediatric Medicine, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
2 Chinese PLA Medical School, Beijing, 100853, China
3 Department of Radiology, Hospital of Jiangxi Provincial Corps, Chinese People’s Armed Police Force, Nanchang, 330030, China
4 Department of Health, Beijing Garrison Security Bureau of the Chinese PLA, Beijing, 100009, China
5 Department of Health Service, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
6 Department of Cardiovascular Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China

* Corresponding Authors: Ran Zhang. Email: ; Gengxu Zhou. Email:
# These authors contributed equally to this work

Congenital Heart Disease 2025, 20(4), 519-530. https://doi.org/10.32604/chd.2025.067164

Received 26 April 2025; Accepted 06 August 2025; Issue published 18 September 2025

Abstract

Background: To investigate the impact of preoperative extracorporeal membrane oxygenation (ECMO) on clinical outcomes in pediatric heart transplantation (PHT). Methods: This retrospective cohort analysis was conducted on 19 pediatric heart transplant recipients, divided into two groups: ECMO and non-ECMO, based on whether preoperative ECMO was utilized. We evaluated the patients’ surgical conditions, postoperative complications, and survival rates. Additionally, the analysis focused on the differences and correlations in clinical characteristics, inflammatory markers, and long-term survival outcomes. Results: There was no statistically significant difference in perioperative survival rates between the ECMO group (85.7%) and the non-ECMO group (83.3%). However, the ECMO group exhibited significantly higher levels of inflammatory markers, including Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-6 (IL-10), Tumor Necrosis Factor-a (TNF-α), and C-reactive protein (CRP), compared to the non-ECMO group (p < 0.05). Notably, IL-6, IL-8, and CRP levels in the ECMO group were found to normalize to the levels of the non-ECMO group 24 h after the operation. The cohort demonstrated a mean donor-recipient weight ratio of 1.38 ± 0.39, with successful cardiac remodeling observed in recipients of oversized grafts, with the highest Donor-Recipient Weight Ratio (DRWR) reaching 3.0. Conclusions: The donor-recipient size mismatch plays a significant role in influencing the success rate of PHT. Despite the inflammatory response and perioperative complications, ECMO proves to be an effective bridging strategy, ultimately enhancing overall outcomes in PHT.

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