ObjectiveTo analyze the risk factors for pediatric heart transplantation at a single center and its impact on short-term prognosis, providing experience and reference for pediatric heart transplantation. MethodsThe children who underwent heart transplantation from May 2022 to May 2024 in the Department of Pediatric Medicine, The Seventh Medical Center of the People's Liberation Army General Hospital were included in this study. We conducted a retrospective analysis of the clinical data of donors and recipients, perioperative conditions, and postoperative complications. The double-lumen venoplasty technique was used for all surgeries. Basiliximab was applied for immune induction during and after the operation (on the 4th day). Tacrolimus+mycophenolate mofetil+prednisolone acetate was used for postoperative immunosuppressive maintenance treatment. According to whether patients had a history of extracorporeal membrane oxygenation (ECMO), they were divided into an ECMO group and a non-ECMO group installation before surgery. The postoperative ICU stay time, postoperative ventilator assistance time, aortic clamping time, extracorporeal circulation time, receptor body surface area, left ventricular ejection fraction, X-ray cardiothoracic ratio, donor heart cold ischemia time, and the weight ratio between donor and recipient were compared between the two groups, and correlation analysis was performed. ResultsA total of 17 children were included, with 10 (58.8%) males and 7 (41.2%) females. Their ages ranged from 7 months to 16 years, with an average age of 11.0 (10.0, 13.0) years. Their weights ranged from 7.0 to 67.5 kg, with an average weight of (41.6±16.7) kg. Of the 17 children, 16 survived post-operation, and 1 died 5 days after the operation. Five patients were ABO blood type-incompatible heart transplantations, and 11patients had a history of ECMO installation before surgery. The left ventricular ejection fraction of the non-ECMO group was higher than that of the ECMO group (t=2.25, P=0.040). The postoperative ICU stay time and postoperative ventilator assistance time (r=0.599, P=0.011), and extracorporeal circulation time (r=0.667, P=0.003) were positively correlated. The cardiothoracic ratio was negatively correlated with the postoperative ventilator assistance time (r=−0.527, P=0.030). ConclusionPediatric heart transplantation is an effective treatment method for children with end-stage heart failure. The left ventricular ejection fraction of the recipient may be a predictive factor indicating that the child needs ECMO assistance. Longer extracorporeal circulation time and larger receptor body surface area may affect the surgical process and perioperative prognosis.