New devices for pediatric mechanical circulatory support

PURPOSE OF REVIEW: In adult patients with advanced heart failure, mechanical circulatory support devices (MCSDs) offer a valid treatment option. MCSDs can serve as a bridge to transplant, bridge to recovery or destination therapy. In the REMATCH trial, MCSDs outperformed medical management for long-term support of end-stage heart failure. Until recently, pediatric patients could not fully benefit from this development due to lack of suitable devices. This review provides an overview of pediatric MCSDs currently available in the US and those in the development stage. We discuss the emerging role of extracorporeal membrane oxygenation compared with MCSDs. RECENT FINDINGS: Small patients with a body-surface area below 0.7 m now have access to the pediatric Berlin Heart Excor. For larger children, several adult MCSDs may be suitable, including the Abiomed BVS-5000, Thoratec, HeartMate and DeBakey MCSD. Five pediatric MCSDs supported by NIH contracts issued in 2004 are now in preclinical testing. Other pediatric MCSDs are already in clinical use abroad on a small scale. SUMMARY: There is mounting experience with MCSDs in children with advanced heart failure. MCSDs will increasingly have to be considered as a treatment option for pediatric heart-transplant candidates and may serve as a bridge to recovery.