Ventricular assist device therapy

Ventricular assist devices (VADs) are invaluable tools for the management of end-stage heart failure in children of all ages. Although development of such devices in adults has advanced substantially in the past few decades through several generations of VAD enhancements, the development of such devices for children has lagged behind. However, the last 10 years have seen increased attention to VAD development and use in the pediatric population. Indeed, in the face of stable or only slightly increased numbers of pediatric donors, the number of pediatric heart transplants has increased significantly, in parallel with the increase in the number of children listed as heart transplant candidates. In part the ability to perform many more transplants with only slightly more donors is reflective of the use of VADs to bridge candidates to transplant who in the pre-VAD era would certainly have died. Nonetheless, of all patients on the waiting list for solid-organ transplantation in the United Sates, children listed for heart transplantation face the highest waiting list mortality, an effect that is especially pronounced in the youngest and smallest children, in whom VAD solutions are least satisfactory. It is anticipated that more children with congenital heart disease and cardiomyopathy-associated heart failure will require long-term VAD support in the coming decade as a bridge to transplantation or recovery.