ORGAN REPLACEMENT THERAPY IN PEDIATRIC HEART FAILURE IN HUNGARY
Vilmányi Csaba
Rácz Károly Konzervatív Orvostudományi Tagozat
Dr. Fekete Andrea
Gottsegen György Országos Kardiológiai Intézet Tanácsterme
2026-06-26 16:00:00
Gyermekkori betegségek klinikuma, élettana és prevenciója
Dr. Szabó Attila
Dr. Ablonczy László
Dr. Mogyorósy Gábor
Dr. Sax Balázs
Dr. Fekete Andrea
Dr. Rózsai Barnabás
Dr. Csizek Zsófia
Pediatric heart failure is a rare but life-threatening condition with etiological characteristics that differ substantially from those observed in adults. In childhood, end-stage heart failure most commonly arises from non-ischemic dilated cardiomyopathy and complex congenital heart disease. In such cases, advanced organ replacement therapies, including heart transplantation (HTX) and mechanical circulatory support (MCS), represent the only definitive treatment options. As these therapies are performed exclusively at our national center, this study provides a comprehensive overview of pediatric organ replacement therapy in Hungary.
Two retrospective analyses were conducted. The heart transplantation cohort included all pediatric patients (<18 years) who underwent HTX between 2007 and 2022 (n=62). Patients were categorized according to underlying diagnosis as cardiomyopathy (CMP, n=42) or congenital heart disease (CHD, n=20). Perioperative variables, rejection episodes, and graft survival were analyzed using appropriate statistical methods, including Kaplan–Meier survival analysis and Cox regression modeling. Overall graft survival during follow-up was 83%. One-year survival was 95.2% in the CMP group and 80% in the CHD group, while five-year survival reached 87.4% and 80%, respectively. Although CHD patients required longer cardiopulmonary bypass and operative times and experienced prolonged mechanical ventilation, no statistically significant difference in long-term mortality was demonstrated between the two groups.
The second study evaluated pediatric patients receiving durable ventricular MCS between 2008 and 2025 (n=27). Patients were divided according to device type into pulsatile paracorporeal and continuous-flow implantable systems. Successful bridge-to-transplantation or recovery was achieved in more than 70% of cases. Continuous-flow devices were associated with lower complication rates and no device-related mortality, whereas pulsatile systems showed higher rates of thromboembolic and bleeding events.
In conclusion, advanced organ replacement therapies in Hungarian pediatric patients provide outcomes comparable to international reference data. Despite increased surgical complexity in congenital heart disease and small children, heart transplantation remains an effective long-term treatment strategy. Mechanical circulatory support significantly reduces waiting list mortality and improves pre-transplant clinical status, with continuous-flow systems demonstrating a more favorable safety profile
