Ventricular assist device support and heart transplantation in congenital heart diseases

Although heart transplantation has been established as definitive therapy for end-stage cardiac failure in infants, children and adults with congenital heart disease, th ere continues to be significant mortality during the waiting interval between listing and transplantation. Centrifugal pumps, extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD) of various design and function principles are in use for temporary support of the failing heart, either aiming at recovery of the heart or more successfully for keeping the patient alive until later transplantation, in the so-called bridge-totransplant concept. Extracorporeal membrane oxygenation and centrifugal pump ventricular assist were suitable for only very short-term application and were associated with significant morbidity, mortality and limitations, especially as the duration of the support extends beyond 2-3 weeks. Anticoagulant treatment and coagulation monitoring and more importantly, earlier decision-making in favor of pump implantation before irreversible shock has set in. Despite the remarkable advances with the use of VAD in adults, it is still limited in very small children (less than 10 kg of body weight).