Pediatric mechanical circulatory support

Abstract

Mechanical circulatory support (MCS) in the pediatric heart failure population has a limited history especially for infants, and neonates. It has been increasingly recognized that there is a rapidly expanding population of children diagnosed and living with heart failure. This expanding population has resulted in increasing numbers of children with medically resistant end-stage heart failure. The traditional therapy for these children has been heart transplantation. However, children with heart failure unlike adults do not have symptoms until they present with end-stage heart failure and therefore, cannot safely wait for transplantation. Many of these children were bridged to heart transplantation utilizing extracorporeal membranous oxygenation as a bridge to transplant which has yielded poor results. As such, industry, clinicians, and the government have refocused interest in developing increasing numbers of MCS options for children living with heart failure as a bridge to transplantation and as a chronic therapy. In this review, we discuss MCS options for short and long-term support that are currently available for infants and children with end-stage heart failure.

Keywords: Cardiac transplantation; Extracorporeal membranous oxygenation; Heart failure; Pediatric; Ventricular assist device.

Fig. 1

Protocol for device selection; name of the devices used in the figure are authors' preference for each device type.

Fig. 2

(A) RotaFlow: pump head and drive unit (Courtesy of MAQUET Cardiovascular). (B) Thoratec PediMag: pump (Courtesy of Thoratec Co.). (C) Tandem Heart: pump (Courtesy of Cardiac Assist Inc.).

Fig. 3

(A) Berlin Heart EXCOR pump (Courtesy of Berlin Heart Inc.). (B) Thoratec IVAD/PVAD (Courtesy of Thoratec Co.). (C) TAH (Courtesy of SynCardia Systems Inc.). (D) HeartWare HVAD (Courtesy of HeartWare Systems). (E) Thoratec HeartMate II (Courtesy of Thoratec Co.).