Approximately one in one hundred children is born with
congenital heart disease. Most can be managed with corrective or
palliative surgery but a small group will develop severe
heart failure, leaving
cardiac transplantation as the ultimate treatment option. Unfortunately, due to the inadequate number of available donor organs, only a small number of patients can benefit from this
therapy, and mortality remains high for pediatric patients awaiting
heart transplantation, especially compared to adults. The purpose of this review is to describe the potential role of mechanical circulatory support in this context and to review current experience. For patients with
congenital heart disease,
ventricular assist devices are most commonly used as a bridge to
cardiac transplantation, an application which has been shown to have several important advantages over medical
therapy alone or support with
extracorporeal membrane oxygenation, including improved survival to transplant, less exposure to blood products with less immune sensitization, and improved organ function. While these devices may improve wait list mortality, the chronic shortage of donor organs for children is likely to remain a problem into the foreseeable future. Therefore, there is great interest in the development of mechanical
ventricular assist devices as potential destination
therapy for
congenital heart disease patients with end-stage
heart failure. This review first discusses the experience with the currently available
ventricular assist devices in children with
congenital heart disease, and then follows to discuss what devices are under development and may reach the bedside soon.