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Advances in the Management of Pediatric Heart Failure: From Medical Therapy to Mechanical Support and Transplantation

Rimsha Ahmad1, Mahesh Kumar2, Saifullah Khan3

  • 1From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY.

Cardiology in Review
|February 4, 2026
PubMed

Insights

Pediatric heart failure presents unique challenges compared to adults, with limited effective treatments. Advances in mechanical support and transplantation offer hope but require further research for better outcomes in children.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Research
  • Clinical Medicine

Background:

  • Pediatric heart failure (PHF) is a severe condition with distinct causes and physiology from adult heart failure.
  • Children with PHF face high rates of morbidity and mortality, with significant progression to death or heart transplantation.
  • Etiologies in children include congenital heart disease, cardiomyopathies, and genetic/metabolic disorders, differing from adult causes.

Purpose of the Study:

  • To review current evidence on medical, mechanical support, and transplant therapies for pediatric heart failure.
  • To highlight age- and condition-specific considerations in managing PHF.
  • To identify research gaps crucial for improving pediatric heart failure outcomes.

Main Methods:

  • Comprehensive literature review of contemporary evidence.
  • Synthesis of data on medical, device-based (mechanical circulatory support), and heart transplantation therapies.
  • Analysis of lesion- and age-specific factors influencing treatment efficacy.

Main Results:

  • Pharmacologic treatments for PHF are largely symptom-modifying with limited outcome improvement, especially in single-ventricle physiology.
  • Mechanical circulatory support and heart transplantation have improved survival but present unique pediatric challenges.
  • Significant differences in myocardial signaling and remodeling in children limit direct application of adult therapies.

Conclusions:

  • Pediatric heart failure management requires tailored approaches due to fundamental differences from adult heart failure.
  • Advances in advanced therapies like VADs and transplantation are vital but necessitate further research.
  • Addressing critical research gaps is essential to enhance long-term outcomes for children with heart failure.

Keywords:
cardiomyopathycongenital heart diseasepediatric heart failure

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