Future of Mechanical Circulatory Support Devices in Children and Young Adults

Mechanical circulatory support has revolutionized heart failure management for adult and pediatric patients alike. Though the field has been marked by near continuous technologic advances, its origins are undoubtedly inauspicious. First performed in 1966, Dr. Michael Debakey described the use of an extracorporeal, pulsatile device to support the circulation of a 37-year-old woman for a mere 10 days (DeBakey, 1971). However, it was not until the early 1990s that the use of ventricular assist device (VAD) technology became routine with the FDA approval of the HeartMate IP left ventricular assist system ( Fig. 55.1A ). This and other similar first generation VADs utilized pneumatically driven, pulsatile pumps to offload the failing ventricle and provide adequate blood flow to reverse the unrelenting course of end-stage heart failure.