Ventricular assist device and mechanical circulatory support for children

Purpose of review There is a growing need for ventricular assist devices in children. These systems have gained wide acceptance as a bridge to heart transplantation and, in some patients, to be explanted following myocardial recovery. We review studies investigating the role of pediatric ventricular assist devices. Recent findings Use of ventricular assist devices supporting the failing heart is now routine in adults, and is being adopted in children. In Europe, only two ventricular assist devices designed for all age groups of children have been approved for commercial use. These devices are extracorporeal and pneumatically driven. In the USA, Food and Drug Administration approval is pending. Modifications of cannula design, use of heparin-coated blood pumps, individualized anticoagulation treatment and monitoring and earlier implantation have led to a significant increase in survival and discharge rate. In addition, for short-term support and expected rapid recovery, extracorporeal membrane oxygenation and centrifugal pumps continue to be applied. Summary In children severe with heart failure, implantation of ventricular assist devices allows bridging to heart transplantation, or may lead to myocardial recovery enabling device explantation. Ventricular assist devices specifically designed for children also offer long-term support in infants previously only eligible for extracorporeal membrane oxygenation.