Adaptations in pediatric VAD support: Fitting the square peg in the round hole

Pediatric end-stage heart failure is a field that has undergone immense change over the past decade as the emerging demand for advanced cardiac therapies has been met with the use of ventricular assist devices (VADs). Though heart transplantation remains the definitive therapy, VAD support has afforded pediatric heart failure patients clinical stability and improved outcomes. However, the use of mechanical circulatory devices designed and intended for adult patients necessitates adaptations in order to be feasible for pediatric support. The inherent limitations to safe and effective VAD support in pediatrics are largely related to patient size restrictions and the challenges presented in supporting patients with congenital heart disease. Though the age of pediatric focused device design is in sight, attempts to address these challenges have largely been through innovation and adaptation of device implantation techniques.