Mechanical Circulatory Support in Pediatric Population: Clinical Considerations, Indications, Strategies, and Postoperative Management

Abstract

The main etiologies leading to end-stage heart failure requiring mechanical support in children are dilated cardiomyopathy, myocarditis, and congenital heart disease. Since end-stage heart failure is rather uncommon in the pediatric population, very few randomized controlled trials have been conducted due to the small number of patients available. Therapeutic guidelines are mainly derived from large adult terminal heart failure studies [1]. Regardless of the underlying etiology, terminal heart failure may present acutely as cardiac arrest or cardiogenic shock or more prolonged in a child with signs of low cardiac output in spite of maximal medical therapy. With failure of the medical therapy, the question arises if mechanical support can/should be applied to save the patient’s life. The clinician has to assess whether short support can be expected to be sufficient or if long-term support is likely needed, if an oxygenator is required, and if only left ventricular support is adequate, or if mechanical support for both ventricles is necessary.