Utilization of Microaxial Mechanical Circulatory Support Among the Pediatric Population: A Systematic Review

Background Utilization of microaxial pumps for temporary mechanical circulatory support in children has increased in recent years. However, data on patient selection, implantation techniques, and outcomes remain limited. Methods A systematic literature search was conducted in July 2025 to identify case reports and case series reporting the use of microaxial pumps in patients aged 18 years or less. Forty‐four studies comprising 100 patients were identified, and patient‐level data were extracted for analysis. Results The median age of the patients was 14 [IQR, 11.5–16] years, with a median weight of 52 [40–73] kg and median body surface area of 1.59 [1.35–1.85] m 2 . The most common diagnoses were cardiomyopathy (29%), heart allograft rejection (26%), and myocarditis (21%). Impella CP was the most frequently used device (48%), followed by Impella 2.5 and Impella 5.5 (each 21%). Access was predominantly obtained via the femoral artery (47%). Percutaneous implantation was performed in 47% of patients. Patients were weaned from microaxial support for cardiac recovery (42%) or heart transplantation (31%). Fourteen patients (14%) died prior to discharge, with significantly higher mortality among patients supported with ECPella (29%) compared with microaxial pump alone (6%; p = 0.01). The median duration of support was 6 [4–13] days. At the median follow‐up of 119 [23–180] days overall survival was 84%. Conclusion Microaxial pumps represent an important addition to temporary mechanical circulatory support in pediatric patients and can serve as an alternative to VA‐ECMO in selected cases. Outcomes were less favorable when used in tandem configurations such as ECPella, reflecting the greater severity of illness in these patients.