Current Global Trends and Challenges of Pediatric Ventricular Assist Device Programs: An ACTION Collaborative Survey

Ventricular assist devices (VADs) have become an established therapy for children with end-stage heart failure, yet multinational data describing pediatric VAD programs remain limited. We conducted a 12 question survey through the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) involving 74 international healthcare professionals from pediatric VAD programs outside North America. The survey assessed device and resource availability, multidisciplinary team composition, program challenges, and future priorities. Fifteen responses representing 15 centers from 14 countries were received, including 13 centers with established pediatric VAD programs. Most centers (91%, 10/11) managed 1-5 pediatric VAD patients annually. Berlin Heart EXCOR and HeartMate 3 were available in 85% (11/13) of centers, while only 46.7% (7/15) had a dedicated VAD coordinator. Major barriers included inadequate education for intensive care unit (ICU) and nursing staff and patients (69%, 9/13), financial constraints (54%, 7/13), limited device availability (46%, 6/13), and lack of outpatient VAD experience, with 31% (4/13) of centers reporting no experience discharging patients on VAD support. Substantial variation in device availability, multidisciplinary resources, and program experience exists across regions. These findings highlight important gaps in pediatric VAD care and support international collaboration to improve education, infrastructure, and access to advanced heart failure therapies.