ABSTRACT
The potential for clinical deterioration in medically-managed children with cardiomyo-
pathy and myocarditis and the increase in complexity and volume of cardiac surgical
procedures performed in neonates and infants have introduced the specific need and
challenge of mechanically supporting the failing pediatric heart as a bridge to either
recovery or transplantation (1-4). The first attempt to achieve post-operative myocardial
recovery with veno-arterial bypass in a pediatric patient was reported by Spencer and
coworkers in 1965 (5,6) and was followed by the first successful case of device-assistance
by De Bakey in 1971 (7). Three decades following these initial reports, several devices are
available as well-established treatment modality of refractory or irreversible cardiac
failure in pediatric patients. Device selection is based on the particular indication for
mechanical assistance (acute, chronic, or post-cardiotomy failure), the anticipated length
of support and, most importantly, the size of the patient (1,8-11). For several years,
extracorporeal membrane oxygenation (ECMO) and non-pulsatile centrifugal pumps have
represented the mainstay of cardiac and pulmonary support in children (1,12).
The limitations of these techniques and the introduction of other devices that allowed
prolonged support in adults prompted their clinical application to larger pediatric patients
with success (13-15). But adaptation of adult support systems to larger children excludes a
substantial segment of the pediatric population that cannot accommodate larger devices.
The field of pediatric circulatory support will therefore likely focus in the years to come on
the development and refinement of ventricular assist devices (VADs) that are specifically
designed for smaller patients, allowing for prolonged mechanical assistance in neonates,
infants, and small children.
