Ventricular assist devices for the failing univentricular circulation.

Improved survival following single ventricle palliation has led to a large population of patients with a univentricular circulation, many of whom develop heart failure. Increasing experience with ventricular assist devices (VAD) in children has paved the way for VAD support in those with failing univentricular circulation. Areas covered: The use of VADs to support the failing univentricular circulation is a relatively new concept. Most studies have focused on supporting patients with the failing systemic ventricle. There are limited reports of VAD support of the pulmonary circulation in patients with Fontan failure despite preserved ventricular function. None of the current VADs have been designed to support the pulmonary circulation. Novel low-pressure, high-flow pumps, specifically designed to support the pulmonary circulation, are under development. Expert commentary: The failing univentricular circulation is one of the great challenges in the field of congenital heart disease. While current VADs are designed to support the systemic circulation, many patients require support of the pulmonary circulation. A fully implantable VAD for support of the pulmonary circulation as destination therapy would be beneficial for patients with preserved systolic function, but must have low energy requirements, negligible risk of stroke and low risk of device thrombosis and failure.