Mechanical circulatory support devices in pediatric patients

Acute heart failure can occur in children as a result of hemodynamic insults imposed on the heart by structural congenital defects or in anatomically normal hearts in which the myocardium is damaged by an inflammatory or infectious process (myocarditis, metabolic diseases leading to cardiomyopathy). Postcardiotomy heart failure following surgical repair of congenital heart defects can also lead to the need for postoperative support. Mechanical circulatory support devices have been used successfully as a bridge to recovery in children, especially in the management of acute myocarditis or postcardiotomy heart failure. The use of these devices as a bridge to transplantation has also been shown to decrease waiting list mortalities and improve the efficiency of donor organ utilizations in children. However, currently available mechanical circulatory support options for infants and children are still quite limited, especially with regard to size options for smaller patients and the long-term duration of support often required. Future devices are currently in development for clinical use on a broad scale and will greatly facilitate the successful support of children with heart failure as a bridge to myocardial recovery or heart transplantation.