Limitations of ventricular assist devices in pediatrics: When one size does not fit all

Ventricular assist device (VAD) use in pediatric heart failure is an evolving field with increasing volume and case complexity of patients supported. Despite this, limited VADs used are developed for infants and children, with significant numbers supported using adult devices. While outcomes on support are influenced by a variety of factors, including illness severity at VAD implant, need for additional right heart support, and presence of congenital heart disease, body size remains an independent predictor of mortality and adverse events on VAD support. Those patients able to accommodate adult-designed implantable continuous-flow VADs experience markedly improved survival outcomes and lower complication rates with improved rehabilitation potential. For the remaining cohort, device choices are limited to extracorporeal VAD support with inferior outcomes and care limited to hospital settings. The deficit in pediatric-specific VAD devices is a well-recognized need to optimize care for this complex cohort.