Mechanical Circulatory Support in Congenital Heart Disease

As early survival outcomes have improved, heart failure in children with congenital heart disease (CHD) has become a growing problem. Primary care providers and pediatricians are thus encountering increasing numbers of children with or at-risk for heart failure. Despite medication, many of these children progress to end-stage heart failure and require heart transplant for long-term survival. Mechanical circulatory support (MCS) is increasingly utilized to support this cohort both acutely when recovery is anticipated, and as a bridge to transplant. Early referral to tertiary heart failure and MCS teams is key to facilitate timely institution of MCS and preserve end-organ function. MCS in children with CHD presents unique challenges due to patient size and complex intra- and extra-cardiac anatomy. Evaluations for MCS should take into account patient size, anatomy, end-organ function, and psychosocial supports. The form of MCS utilized is dependent on clinical urgency, patient size, and anatomy. We describe the evolving landscape of MCS in pediatric patients with CHD.