Patient and Device Selection in Pediatric MCS: A Review of Current Consensus and Unsettled Questions

Area of Science:

• Pediatric Cardiology
• Mechanical Circulatory Support
• Heart Failure Management

Background:

• Pediatric ventricular assist device (VAD) use has grown substantially, with one-third of pediatric heart transplant recipients now bridged with a VAD.
• Despite increased utilization, formal guidelines for patient or device selection in pediatric VAD therapy are limited.
• Outcomes in pediatric VAD support are known to vary based on patient size, anatomy, illness severity, and device type.

Purpose of the Study:

• To survey current practice patterns in pediatric VAD patient and device selection.
• To review existing literature on VAD outcomes specific to pediatric patient populations.
• To identify patient groups lacking a consensus approach for optimal VAD outcomes, guiding future research.

Main Methods:

• Survey of clinical decision-making among member sites of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION).
• Comprehensive literature review focusing on patient population-specific VAD outcomes.
• Analysis of center-specific practices related to patient and device selection in pediatric VADs.

Main Results:

• Current pediatric VAD practice patterns reveal heterogeneity in patient and device selection.
• Significant variation in VAD outcomes exists across different pediatric patient subgroups.
• Specific pediatric populations lack a clear consensus for achieving optimal VAD outcomes.

Conclusions:

• Contemporary approaches to pediatric VAD patient and device selection are presented.
• Key populations requiring further research and quality improvement efforts for VAD therapy are highlighted.
• Addressing knowledge gaps in VAD selection for specific pediatric groups is crucial for improving outcomes.