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Mechanical circulatory support for infants and children with cardiac disease
1Pediatric and Congenital Heart Surgery, Cleveland Clinic Children's Hospital, Ohio 44195, USA. duncanb@ccf.org
Insights
Mechanical circulatory support is expanding in congenital heart surgery. Newer pulsatile devices and developing continuous flow systems offer improved options for pediatric patients needing heart assistance.
Area of Science:
- Pediatric cardiac surgery
- Mechanical circulatory support devices
Background:
- Mechanical circulatory support (MCS) is increasingly vital in congenital cardiac surgery.
- Extracorporeal membrane oxygenation (ECMO) and centrifugal ventricular assist devices (VADs) are currently standard for pediatric MCS.
Purpose of the Study:
- To review the evolving role and emerging technologies of MCS in pediatric congenital heart surgery.
Main Methods:
- Review of current literature and emerging technologies in pediatric mechanical circulatory support.
Main Results:
- Pulsatile paracorporeal VADs designed for pediatric use are gaining traction.
- New continuous flow devices, initially for adults, may become applicable for pediatric patients.
Conclusions:
- The landscape of MCS for pediatric congenital heart surgery is rapidly advancing.
- Future MCS options for children include improved pulsatile devices and potentially adapted adult continuous flow systems.
Abstract:
Mechanical circulatory support is assuming an expanding role in the practice of congenital cardiac surgery. Extracorporeal membrane oxygenation and centrifugal ventricular assist devices are still the mainstay of mechanical circulatory support for children; however, newly developed pulsatile, paracorporeal ventricular assist devices designed for pediatric applications are achieving increased utilization. In addition, several new, continuous flow devices that are under development as fully implantable systems for adults, ultimately may be useful for pediatric patients.