Pediatric mechanical circulatory support: available devices and outcomes as bridge-to-transplant therapy.

PURPOSE OF REVIEW: The use of mechanical circulatory support in children has increased dramatically over the current decade. A review of the pediatric ventricular assist device (VAD) literature is timely and relevant in order to improve outcomes and refine patient selection as new devices become available and current VADs are used in smaller patients.

RECENT FINDINGS: Outcomes of pediatric patients bridged to transplant with VAD therapy continue to improve. Patient selection in children continues to be complex as size and anatomy make decision-making unique from the adult practice. In addition, device selection and surgical planning are evolving in children. The use of temporary devices for long-term use is an example of an innovative application of current technology. Sensitization and adverse events are important issues that are necessary to understand in order to improve outcomes. The importance of a national registry to help monitor patient outcomes is critical to assessing this highly technological therapy.

SUMMARY: There are many implications of improving and expanding durable device use in children. VAD therapy is evolving as a standard of care as a bridge to transplant in children. Continued surveillance of outcomes is critical to improving patient selection and decreasing adverse events in children with advanced heart failure.