TY  - EJOU
AU  - Yi, Hui 
AU  - Shi, Hongjian 
AU  - Kan, Fuquan 
AU  - Han, Fan 
AU  - Wan, Lei 
AU  - Hong, Xiaoyang 
AU  - Zhao, Zhe 
AU  - Shao, Junjie 
AU  - Wang, Gang 
AU  - Wang, Hui 
AU  - Yan, Hua 
AU  - Shi, Xiujuan 
AU  - Zhang, Ran 
AU  - Zhou, Gengxu 

TI  - Preoperative ECMO Bridging in Pediatric Heart Transplantation: A Cohort Study on Graft Remodeling, Inflammatory Biomarkers and Survival
T2  - Structural and Congenital Heart Disease

PY  - 2025
VL  - 20
IS  - 4
SN  - 3071-1738

AB  - <b>Background:</b> To investigate the impact of preoperative extracorporeal membrane oxygenation (ECMO) on clinical outcomes in pediatric heart transplantation (PHT). <b>Methods:</b> 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. <b>Results:</b> 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 (<i>p</i> < 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. <b>Conclusions:</b> 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.
KW  - Pediatric heart transplantation; donor-recipient weight ratio; extracorporeal membrane oxygenation; cytokine

DO  - 10.32604/chd.2025.067164