Technology insight: use of ventricular assist devices in children

Mechanical circulatory support systems for the treatment of end-stage heart failure are now available for a wide variety of clinical situations and support times. Extracorporeal membrane oxygenation and centrifugal pump circuits have been most widely used in children, particularly in small infants. These systems are preferred for support after cardiac operations and for use in patients who have concomitant respiratory failure, but are suitable for short-term application only and intensive care is obligatory. True ventricular assist devices (VADs) qualify for long-term application and allow patients full mobilization. These features are important in patients awaiting heart transplantation as well as in those with myocarditis and cardiomyopathy, who might achieve complete cardiac recovery. Pneumatic pulsatile VADs have been available in pediatric sizes since 1992. At our institution, VAD use lasting from several days to 14 months in 70 infants and children with myocarditis and cardiomyopathy has led to a notable rise in survival in the past 5 years. We have been able to discharge 78% of the infants under 1 year old. In this review we present current VAD experience in children in the light of improvements in decision making, device technology, implantation techniques, and in coagulation monitoring and anticoagulation.