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Limitations of ventricular assist devices in pediatrics: When one size does not fit all

Áine Lynch1,2, Aamir Jeewa1,2

  • 1Division of Pediatric Cardiology, Columbia University Medical Center, New York Presbyterian Morgan Stanley Children's Hospital, New York, NY.

JHLT Open
|February 3, 2026
PubMed

Insights

Pediatric heart failure patients need better ventricular assist devices (VADs). Body size impacts outcomes, and a lack of pediatric VADs limits care, especially for smaller children.

Area of Science:

  • Pediatric Cardiology
  • Biomedical Engineering
  • Mechanical Circulatory Support

Background:

  • Ventricular assist device (VAD) use is increasing in pediatric heart failure.
  • Limited VAD options exist for infants and children, with many using adult devices.
  • Body size is a critical factor influencing VAD outcomes in pediatric patients.

Purpose of the Study:

  • To review the current landscape of VAD use in pediatric heart failure.
  • To highlight the challenges posed by the lack of pediatric-specific VADs.
  • To emphasize the impact of body size on VAD outcomes and survival.

Main Methods:

  • Review of current literature on VADs in pediatric heart failure.
  • Analysis of factors affecting VAD outcomes, including device type and patient characteristics.
  • Examination of the disparity between adult and pediatric VAD device availability.

Main Results:

  • Patients who can utilize adult-sized implantable continuous-flow VADs show improved survival and fewer complications.
  • Smaller pediatric patients often require extracorporeal VAD support, which is associated with poorer outcomes.
  • Body size is an independent predictor of mortality and adverse events in pediatric VAD recipients.

Conclusions:

  • There is a significant need for the development of VADs specifically designed for pediatric patients.
  • Optimizing VAD care for children requires addressing the limitations of current device options.
  • Pediatric-specific VADs are essential to improve survival and reduce complications in this population.

Keywords:
Body sizeMechanical circulatory supportOutcomesPediatric heart failureVentricular assist device

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