Abstract
In the past 2 decades, pediatric mechanical circulatory support (MCS) strategies have improved. Focus on ventricular assist devices (VAD) is an important topic for pediatric heart failure patients and single ventricle palliation. Application of VADs continues to evolve, including implanting compact adult continuous-flow devices to larger children (HeartMate 3) along with the recent discontinuation of the HeartWare. The Berlin Heart ExCOR has received improved outcomes with adjustments to anticoagulation. Syncardia Total Artificial Heart has also released a smaller version which has been implanted in adolescents. Advanced cross-sectional imaging can now be used for pre-operative planning of device placement. Finally, special consideration is required for usage of these devices in a failing Fontan circulation (univentricular physiology) with some lab studies and small cases highlighting the unique challenges. The potential options for VAD as a bridge to transplant, destination therapy, or recovery continue to expand the crucial role of MCS in congenital heart disease. Smaller patient size, limited availability of organs for heart transplant, and longer survival of pediatric congenital patients continues to make innovation in MCS necessary.