Mechanical circulatory support for infants and small children.

The development of mechanical circulatory support devices for infants and small children with heart failure has significantly lagged behind the development of devices for adults. In the United States, there was really very little activity focused on the development and implementation of durable mechanical assist devices for small children until the early part of this millennium. At present, the Berlin Heart EXCOR Pediatric ventricular assist device (Berlin Heart Inc., The Woodlands, TX) is currently the only device available to provide long-term support to small children awaiting cardiac transplantation; this device is only available through either compassionate use solicitation or within the confines of an ongoing investigation device exemption trial. There are several other devices being developed at this time, but it will be years before they are tested in clinical trials. In this article, we will review the current status of mechanical circulatory support devices and therapy strategies for infants and small children presenting in acute heart failure.