ABSTRACT
The most common indication for mechanical circulatory support in children is for contractile dysfunction following reconstructive cardiac surgery. More recently, however, with the expanded use of cardiac transplantation in patients with congenital heart defects, there is a growing experience with mechanical support of children awaiting transplantation (1). Similarly, due to the encouraging shortand long-term results with the use of extracorporeal membrane oxygenation (ECMO) in children following cardiac arrest, there is increasing experience with ECMO support for posttransplant patients having severe graft dysfunction from rejection (2). We have established a program for mechanical circulatory support in children as a bridge to transplantation and for "rescue" therapy in cases of severe rejection and hemodynamic instability. Based on previous observations, we have developed criteria defining indications for support and criteria for decision making in the management of circulatory support. In this report we describe our methods of management of circulatory support, indications for use as bridge to transplant or as "rescue" therapy posttransplant, and results from 1990 to the present.
