Mechanical circulatory support in children: past, present and future

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Biomedical Engineering

Background:

• Heart failure management in children has evolved significantly.
• Mechanical circulatory support (MCS) plays a crucial role in advanced pediatric heart failure.
• Ventricular assist devices (VADs) are increasingly utilized in pediatric care.

Purpose of the Study:

• To highlight the impact of recent advancements in MCS on pediatric heart failure management.
• To emphasize the importance of timely VAD implantation for end-organ function preservation.
• To discuss the evolving landscape of post-implant care and its effect on outcomes.

Main Methods:

• Review of current literature and clinical practices in pediatric MCS.
• Analysis of outcomes related to VAD implantation in pediatric patients.
• Examination of strategies for post-implant management, including stroke risk reduction.

Main Results:

• Significant decrease in transplant waitlist mortality attributed to VAD use.
• Successful off-label use of adult-approved devices in children.
• Improved end-organ function preservation and recovery post-VAD implantation.
• Establishment of chronic VAD therapy and home discharge as viable options.

Conclusions:

• Mechanical circulatory support, particularly VADs, has revolutionized pediatric heart failure treatment.
• Optimized timing of VAD implantation and enhanced post-implant care are critical for improving patient outcomes.
• The use of VADs offers a viable therapeutic option, reducing waitlist mortality and enabling long-term management outside the hospital.