Purpose: To evaluate the effectiveness of mechanical bridging (MB) to heart transplantation (HT) both short and longer term for this patient group.
Materials and Methods: Prior to 2004 at this institution, children <10 kg were excluded from MB due to longer waits for suitable organs. In 2004, MB with Berlin Heart Excor (BH) VAD, allowed the team to extend the support time available and included <10 kg patient into the bridging programme. This is a report of our experience to date and outcomes.

Results: Since the program began 17 patients have been bridged with BH, 8 <10 kg. Of these 9 (53%) were bridged with BH alone and 8 (47%) had ECMO followed by BH. Twelve (71%) patients were supported with L-VAD, 5 (29%) Bi-VAD. The average weight was 23 kg (range 6 - 90 kg). The median (IQR) support time was 57 (20, 98) days as compared to 14 (11, 18) days in those with BH > 10 kg (p=0.23). Thirteen (76%) survived to OHT. The median (IQR) time to hospital discharge was similar across weight range and type of supported provided.

Conclusion: Mechanical bridge to HT is a developing service and now includes the patient category of <10 kg: it provides extended bridging time with 76% survival to heart transplantation, low morbidity and excellent post-transplant recovery improving service provision. Expansion of patient support in this group, has future challenges as to where these children should be cared for.