Pediatric circulatory support: current strategies and future directions. Biventricular and univentricular mechanical assistance.

Mechanical circulatory support is gaining increased recognition as a viable treatment option for pediatric patients who suffer from congenital or acquired heart disease. Historically, the treatment options have been very limited for pediatric patients, but recent technological advances, combined with new research into circulatory support devices, are seeking alternative therapeutics options for infants and children. We present a review of the technological advances of mechanical circulatory support in the pediatric population, including the recent emergence of a new class of circulatory support devices for pediatric patients with single ventricle physiology. The National Heart, Lung, and Blood Institute pediatric circulatory support program is discussed, in addition to the use of adult devices in pediatric applications, the Berlin Heart Excor, and several other blood pumps in development for bridge-to-transplant and bridge-to-recovery support. These devices have the potential to generate a paradigm shift in the treatment of the pediatric patients with heart failure--a shift is likely already be underway.