Background: Mechanical cardiac support is currently an effective strategy to reduce morbidity and mortality in pediatric patients. However, solid evidence regarding the feasibility of intracorporeal devices in children still needs to be provided. We report our 10‐year experience with intracorporeal left ventricular assist devices (LVAD) in children.Materials and Methods: We included all patients undergoing intracorporeal, continuous‐flow LVAD implantation between 2012 and 2022. Baseline and postoperative data were collected from the institutional database.Results: Seven HeartWare and 4 HeartMate3 were implanted in 11 patients (median age 13.9 years, median body surface area – BSA – 1.42 m², IQR 1.06–1.68). The most frequent indication to LVAD implant was dilated cardiomyopathy (72.7%). All candidates underwent a thorough preoperative advanced imaging. Three‐dimensional reconstructions and implant fit simulation were performed when BSA was <1.2 m², weight <30 kg, or internal transverse thoracic diameter 1.0 m². In borderline cases, the 3D reconstruction with implant fit simulation can effectively help to identify those patients who can safely undergo intrathoracic LVAD implantation.

Aims: this study sought to compare midterm outcomes of low-risk patients who underwent surgical aortic valve replacement (SAVR) vs balloon expandable (BE) or self-expandable (SE) TAVI. Methods: data of consecutive patients undergoing SAVR or transfemoral TAVI between 2017 and 2022 were collected. Patients were separated in 3 groups according to the type of prosthesis: biological surgical prosthesis, BE prosthesis and SE prosthesis. The 3 groups were compared in terms of baseline characteristics, post-procedural outcomes and long-term survival. Results: 542 patients were enrolled. 221 received a surgical prothesis, 150 received a BE prosthesis and 171 a SE prosthesis. TAVI patients were older and with a higher risk profile compared to surgical patients. Propensity score matching resulted in an excellent matching of nearly 80 patients in each group. In the matched cohort, SE prostheses were associated with a significantly higher incidence of stroke (SE group 6.3%, BE group 0, SAVR group 2.3%, p=0.045), para-valvular leak (SE group 8.1%, BE group 2.4%, SAVR group 0, p=0.017) and left bundle branch block (SE group 23.8%, BE group 18.2%, SAVR group 0 %, p< 0.001). Regarding 5-year mortality no significant differences were reported between BE and SE TAVI (13.6% vs22.5%, p=0.066). However, when comparing surgery versus TAVI, SE prosthesis showed a significantly higher 5-year mortality (22.5% vs 11.6%, p=0.042). Instead, BE prosthesis demonstrated their non inferiority compared to surgical prosthesis (13.6% vs 11.6%, p=0.249). Conclusion: BE prosthesis should be considered the prosthesis of choice for patients with long life-expectancy requiring a transcatheter procedure.

Objectives: This study sought to compare midterm outcomes of low-risk patients who underwent a surgical aortic valve replacement (SAVR) vs. balloon-expandable (BE) or self-expandable (SE) transcatheter aortic valve implantation (TAVI). Methods: Data on consecutive patients undergoing SAVR or transfemoral TAVI between 2017 and 2022 were collected. Patients were separated into three groups according to the type of prosthesis: a biological surgical prosthesis, BE prosthesis and SE prosthesis. The three groups were compared in terms of baseline characteristics, post-procedural outcomes and long-term survival. Results: A total of 542 patients were enrolled, and 221 received a surgical prothesis, 150 received a BE prosthesis and 171 received an SE prosthesis. TAVI patients were older and had a higher risk profile compared to surgical patients. Propensity score matching resulted in an excellent matching of nearly 80 patients in each group. In the matched cohort, SE prostheses were associated with a significantly higher incidence of stroke (SE group 6.3%, BE group 0, SAVR group 2.3%, p = 0.045), para-valvular leak (SE group 8.1%, BE group 2.4%, SAVR group 0, p = 0.017) and left bundle branch block (SE group 23.8%, BE group 18.2%, SAVR group 0%, p < 0.001). Regarding 5-year mortality, no significant differences were reported between the BE and SE TAVI (13.6% vs. 22.5%, p = 0.066). However, when comparing surgery versus TAVI, the SE prosthesis showed a significantly higher 5-year mortality (22.5% vs. 11.6%, p = 0.042). Instead, the BE prosthesis demonstrated its non-inferiority compared to the surgical prosthesis (13.6% vs. 11.6%, p = 0.249). Conclusions: The BE prosthesis should be considered the prosthesis of choice for patients with a long life expectancy requiring a transcatheter procedure.