Mechanical circulatory support devices for pediatric patients

Pediatric mechanical circulatory support (MCS) therapy has predominantly been used to treat perioperative heart failure in patients undergoing congenital heart surgical repair. Extracorporeal membrane oxygenation (ECMO) continues to be the primary option for acute and short-term MCS therapy after cardiac surgical repair. The use of veno-arterial ECMO has significantly improved the surgical outcomes of patients undergoing congenital heart surgery. More recently, MCS therapy is increasingly being utilized to support pediatric patients with end-stage heart failure awaiting heart transplantation. The Berlin Heart Excor ventricular assist device (VAD) is currently the only FDA approved durable device available for long-term support in infants and children. Some of the devices designed for use in adults have received approval for use in older children. The use of these devices as a bridge to transplantation has been shown to decrease waiting list mortalities and improve the efficiency of donor organ utilizations in children. However, the currently available mechanical circulatory support options for infants and children are still quite limited, especially with regard to options for smaller patients and patients with complex cardiac lesions.