Pediatric Mechanical Circulatory Support

Darren Turner, MD, Chet R. Villa, MD, Awais Ashfaq, MD, David L. S. Morales, MD

Key Points

  • Ventricular assist devices (VADs) have transformed the care of patients with pediatric cardiac failure, with devices like the Berlin Heart EXCOR and continuous-flow VADs significantly increasing transplant waitlist survival and annual pediatric heart transplant volume.
  • Device selection is driven by patient size and diagnosis, with larger children and those with dilated cardiomyopathy having better outcomes than infants or patients with complex congenital heart disease.
  • Extracorporeal membrane oxygenation (ECMO) remains essential for perioperative and emergent support, but temporary VADs may offer advantages in isolated ventricular dysfunction.
  • Center experience and collaborative networks are key to improving outcomes, as most centers have low annual pediatric VAD volumes, making shared protocols and data critical.
  • Ongoing challenges include the need for more device options for infants and complex cases, highlighting the importance of continued innovation and multi-center collaboration.

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