Current Challenges and Strategies of Ventricular Assist Device Support in Infants and Small Children

Abstract

Ventricular assist devices (VADs) have become a mainstay of advanced heart failure therapy in pediatrics, with outcomes in adolescents that parallel the excellent outcomes in adults. Unfortunately, outcomes for younger children and infants remain suboptimal. This review discusses the patient and device specifics that contribute to this discrepant outcome, highlight current treatment strategies, and suggest areas for future improvement. The field of pediatric mechanical circulatory support (MCS) continues to be driven by advancements in patient selection, timing of VAD implantation, and patient management strategies particularly with regard to anticoagulation. The use of direct thrombin inhibitors, such as bivalirudin, and weight-based antiplatelet therapy has shown promise in reducing the incidence of bleeding and stroke. While the number of devices remains limited, providers continue to leverage current technology and novel cannulation strategies to support smaller and more complex patients. Despite the challenges of supporting infants and small children, it remains a hopeful time for the field of pediatric MCS. While individual centers may only care for small number of VAD patients, the ACTION learning network has sparked collaboration across the field broadly with rapid dissemination of best practices to all centers. This collaboration has led to many advances and holds promise for driving future advancements.