The use of ventricular assist device support in children: the state of the art.

Improved survival, recognition, and management of patients with congenital heart disease have increased the number of pediatric patients with ventricular dysfunction. Many of these patients require mechanical support to bridge to transplant or recovery. Development of pediatric ventricular assist devices has lagged behind adult devices. Until recently, adult devices were used in pediatric patients, with suboptimal results in the smaller patient population. Extracorporeal membrane oxygenation can be life saving, but is a poor choice for long-term support. The Berlin Heart EXCOR (Berlin Heart AG, Berlin, Germany) is a paracorporeal device with a variety of pumps for patients of all sizes. The PumpKIN Trial will compare this device to the Infant Jarvik 2000 (Jarvik Heart, New York, NY, USA) in a prospective, randomized study. The single ventricle population presents unique challenges to placement and proper functioning of assist devices. Data are anecdotal and mortality is high. A registry has been developed to assist in caring for this challenging population.