PMC:6640909 / 81768-86561 JSONTXT

{"project":"TEST0","denotations":[{"id":"31100109-122-129-7626","span":{"begin":306,"end":309},"obj":"[\"28365175\"]"},{"id":"31100109-233-240-7627","span":{"begin":424,"end":427},"obj":"[\"30184070\"]"},{"id":"31100109-113-120-7628","span":{"begin":734,"end":737},"obj":"[\"28365175\"]"},{"id":"31100109-122-129-7629","span":{"begin":743,"end":746},"obj":"[\"28125462\"]"},{"id":"31100109-81-88-7630","span":{"begin":830,"end":833},"obj":"[\"26720740\"]"},{"id":"31100109-234-241-7631","span":{"begin":1137,"end":1140},"obj":"[\"28365175\"]"},{"id":"31100109-235-242-7632","span":{"begin":1142,"end":1145},"obj":"[\"25454394\"]"},{"id":"31100109-231-238-7633","span":{"begin":1147,"end":1150},"obj":"[\"28259596\"]"},{"id":"31100109-188-195-7634","span":{"begin":1502,"end":1505},"obj":"[\"28365175\"]"},{"id":"31100109-193-200-7635","span":{"begin":1507,"end":1510},"obj":"[\"24002006\"]"},{"id":"31100109-198-205-7636","span":{"begin":1512,"end":1515},"obj":"[\"27009673\"]"},{"id":"31100109-235-242-7637","span":{"begin":1602,"end":1605},"obj":"[\"28365175\"]"},{"id":"31100109-232-239-7638","span":{"begin":1612,"end":1615},"obj":"[\"25612114\"]"},{"id":"31100109-232-239-7639","span":{"begin":1617,"end":1620},"obj":"[\"26776864\"]"},{"id":"31100109-233-240-7640","span":{"begin":1622,"end":1625},"obj":"[\"27009673\"]"},{"id":"31100109-126-133-7641","span":{"begin":1754,"end":1757},"obj":"[\"19920051\"]"},{"id":"31100109-108-115-7642","span":{"begin":1868,"end":1871},"obj":"[\"28365175\"]"},{"id":"31100109-118-125-7643","span":{"begin":1878,"end":1881},"obj":"[\"27056612\"]"},{"id":"31100109-123-130-7644","span":{"begin":1883,"end":1886},"obj":"[\"27009673\"]"},{"id":"31100109-98-105-7645","span":{"begin":2238,"end":2241},"obj":"[\"27836026\"]"},{"id":"31100109-103-110-7646","span":{"begin":2243,"end":2246},"obj":"[\"28486624\"]"},{"id":"31100109-108-115-7647","span":{"begin":2248,"end":2251},"obj":"[\"24290716\"]"},{"id":"31100109-91-98-7648","span":{"begin":2418,"end":2421},"obj":"[\"27836026\"]"},{"id":"31100109-96-103-7649","span":{"begin":2423,"end":2426},"obj":"[\"24290716\"]"},{"id":"31100109-101-108-7650","span":{"begin":2428,"end":2431},"obj":"[\"19332269\"]"},{"id":"31100109-118-125-7651","span":{"begin":2795,"end":2798},"obj":"[\"23411780\"]"},{"id":"31100109-123-130-7652","span":{"begin":2800,"end":2803},"obj":"[\"22421403\"]"},{"id":"31100109-68-75-7653","span":{"begin":2874,"end":2877},"obj":"[\"22336753\"]"},{"id":"31100109-76-83-7654","span":{"begin":2956,"end":2959},"obj":"[\"28007058\"]"},{"id":"31100109-214-221-7655","span":{"begin":3917,"end":3920},"obj":"[\"28007058\"]"},{"id":"31100109-124-131-7656","span":{"begin":4047,"end":4050},"obj":"[\"28009714\"]"},{"id":"31100109-94-101-7657","span":{"begin":4507,"end":4510},"obj":"[\"28365175\"]"},{"id":"31100109-103-110-7658","span":{"begin":4516,"end":4519},"obj":"[\"28781147\"]"},{"id":"31100109-116-123-7659","span":{"begin":4788,"end":4791},"obj":"[\"28365175\"]"}],"text":"11. PAEDIATRIC OPERATIVE TECHNIQUES\n\n11.1 Introduction\nThe success rate of bridging children with MCS to a transplant or recovery using pulsatile or CF devices has improved with time. In the latest PEDIMACS report, an 84% 6-month survival rate on devices was reported with a transplant rate of nearly 50% [275], whereas the first Paedi-EUROMACS report shows a 6-month survival of 81% and a transplant rate of more than 50% [276]. Paediatric data on intracorporeal devices from EUROMACS demonstrated an on-device survival rate of 89% at 12 months [277]. Originally, the MCS devices used were mainly paracorporeal devices. More recently, an increase in the use of CF-LVAD in paediatric patients and patients with CHD has been reported [275, 278–281]. The obvious advantage is the ability to discharge these young patients home [282–286].\n\n11.2 Small children—system selection\nDevice selection in children and patients suffering from CHD (see section below) differs significantly from that in adults with anatomically normal hearts and also differs substantially among paediatric groups depending on age and the type of CHD of the patient [275, 287, 288]. The Berlin Heart EXCOR® Paediatric VAD is currently the only VAD specifically designed and approved for the paediatric population in the USA, Europe and Canada.\nIn paediatric patients with a body surface area \u003e1.2 m2 requiring MCS, the use of an implantable CF-LVAD is feasible because results are non-inferior to those with extracorporeal devices [275, 289, 290], and discharge from the hospital is possible, resulting in a better quality of life [275, 277, 284, 285, 290]. In adults, CF-VADs have improved survival and greater freedom from stroke and device failure compared with pulsatile devices [147]. This result seems to be true also for paediatric patients with a body surface area \u003e1.2 m2 and without CHD [275, 277, 279, 290].\n\n11.3 Single ventricle—Fontan haemodynamics\nApproximately 5–10% of children born with CHD suffer from an underdeveloped LV or RV, leading to single ventricle physiology. Large studies on the use of MCS in patients with a single ventricle are lacking. Only case reports or small case series have been published, and they report high mortality rates [283, 291, 292]. However, implantation of VADs in various locations seems to be feasible.\nThe feasibility of VAD support for Glenn circulation has been reported with mixed results [283, 292, 293]. After the Fontan circulation has been created, there are 2 possibilities of failure: systemic ventricular failure or failure at the level of the cavopulmonary connection. Currently available VADs are designed to support the failing ventricle. Nevertheless, available devices have been used for cavopulmonary support in patients with failing Fontan circulation [294, 295]. Others use clinically available VADs as a bridge to transplant [296–299]. For patients with failing Fontan circulation, TAH might be a viable option [300]. In cases of failing Fontan circulation and ventricular failure, the BiVAD remains an option but requires revision of the Fontan pathway to allow the separation of the systemic venous and pulmonary circulations, which can be very demanding.\n\n11.4 Total artificial heart\nA certain percentage of patients require biventricular support with either BiVAD placement or implantation of a TAH. The 70-cc TAH (SynCardia Systems Inc., Tucson, AZ, USA) is currently the only Food and Drug Administration (FDA)-approved and Conformité Européenne (CE)-marked TAH licensed for bridge to transplant or destination therapy. However, this device is limited to patients with a larger chest cavity with adequate intrathoracic space to accommodate this device. The 50 cc-TAH (currently under investigation for FDA approval) is more appropriate for use in smaller patients, especially in complex cases who have had limited clinical options such as failing Fontan circulation [300]. Unsurprisingly, reported outcomes in patients ≤21 years supported with a TAH seem to be inferior to LVAD-only implantation [301].\n\n11.5 Special cases\nBesides the ‘single ventricle physiologies’, CHD includes a wide spectrum of cardiac anatomical configurations, including surgically corrected transposition of the great arteries using the atrial switch procedure (Senning or Mustard operation) at infancy/childhood or patients with corrected congenital transposition of the great arteries. VAD placement in these patients is possible, and some patients will benefit from VAD support [275, 302–307]. However, limited data make standardized recommendations impossible. Each case has to be discussed individually, preferably by a dedicated heart team. Adult CHD and non-adult CHD patients supported by LVADs demonstrate similar survival regardless of cardiac anatomy [275]."}

{"project":"MyTest","denotations":[{"id":"31100109-28365175-28905686","span":{"begin":306,"end":309},"obj":"28365175"},{"id":"31100109-30184070-28905687","span":{"begin":424,"end":427},"obj":"30184070"},{"id":"31100109-28365175-28905688","span":{"begin":734,"end":737},"obj":"28365175"},{"id":"31100109-28125462-28905689","span":{"begin":743,"end":746},"obj":"28125462"},{"id":"31100109-26720740-28905690","span":{"begin":830,"end":833},"obj":"26720740"},{"id":"31100109-28365175-28905691","span":{"begin":1137,"end":1140},"obj":"28365175"},{"id":"31100109-25454394-28905692","span":{"begin":1142,"end":1145},"obj":"25454394"},{"id":"31100109-28259596-28905693","span":{"begin":1147,"end":1150},"obj":"28259596"},{"id":"31100109-28365175-28905694","span":{"begin":1502,"end":1505},"obj":"28365175"},{"id":"31100109-24002006-28905695","span":{"begin":1507,"end":1510},"obj":"24002006"},{"id":"31100109-27009673-28905696","span":{"begin":1512,"end":1515},"obj":"27009673"},{"id":"31100109-28365175-28905697","span":{"begin":1602,"end":1605},"obj":"28365175"},{"id":"31100109-25612114-28905698","span":{"begin":1612,"end":1615},"obj":"25612114"},{"id":"31100109-26776864-28905699","span":{"begin":1617,"end":1620},"obj":"26776864"},{"id":"31100109-27009673-28905700","span":{"begin":1622,"end":1625},"obj":"27009673"},{"id":"31100109-19920051-28905701","span":{"begin":1754,"end":1757},"obj":"19920051"},{"id":"31100109-28365175-28905702","span":{"begin":1868,"end":1871},"obj":"28365175"},{"id":"31100109-27056612-28905703","span":{"begin":1878,"end":1881},"obj":"27056612"},{"id":"31100109-27009673-28905704","span":{"begin":1883,"end":1886},"obj":"27009673"},{"id":"31100109-27836026-28905705","span":{"begin":2238,"end":2241},"obj":"27836026"},{"id":"31100109-28486624-28905706","span":{"begin":2243,"end":2246},"obj":"28486624"},{"id":"31100109-24290716-28905707","span":{"begin":2248,"end":2251},"obj":"24290716"},{"id":"31100109-27836026-28905708","span":{"begin":2418,"end":2421},"obj":"27836026"},{"id":"31100109-24290716-28905709","span":{"begin":2423,"end":2426},"obj":"24290716"},{"id":"31100109-19332269-28905710","span":{"begin":2428,"end":2431},"obj":"19332269"},{"id":"31100109-23411780-28905711","span":{"begin":2795,"end":2798},"obj":"23411780"},{"id":"31100109-22421403-28905712","span":{"begin":2800,"end":2803},"obj":"22421403"},{"id":"31100109-22336753-28905713","span":{"begin":2874,"end":2877},"obj":"22336753"},{"id":"31100109-28007058-28905714","span":{"begin":2956,"end":2959},"obj":"28007058"},{"id":"31100109-28007058-28905715","span":{"begin":3917,"end":3920},"obj":"28007058"},{"id":"31100109-28009714-28905716","span":{"begin":4047,"end":4050},"obj":"28009714"},{"id":"31100109-28365175-28905717","span":{"begin":4507,"end":4510},"obj":"28365175"},{"id":"31100109-28781147-28905718","span":{"begin":4516,"end":4519},"obj":"28781147"},{"id":"31100109-28365175-28905719","span":{"begin":4788,"end":4791},"obj":"28365175"}],"namespaces":[{"prefix":"_base","uri":"https://www.uniprot.org/uniprot/testbase"},{"prefix":"UniProtKB","uri":"https://www.uniprot.org/uniprot/"},{"prefix":"uniprot","uri":"https://www.uniprot.org/uniprotkb/"}],"text":"11. PAEDIATRIC OPERATIVE TECHNIQUES\n\n11.1 Introduction\nThe success rate of bridging children with MCS to a transplant or recovery using pulsatile or CF devices has improved with time. In the latest PEDIMACS report, an 84% 6-month survival rate on devices was reported with a transplant rate of nearly 50% [275], whereas the first Paedi-EUROMACS report shows a 6-month survival of 81% and a transplant rate of more than 50% [276]. Paediatric data on intracorporeal devices from EUROMACS demonstrated an on-device survival rate of 89% at 12 months [277]. Originally, the MCS devices used were mainly paracorporeal devices. More recently, an increase in the use of CF-LVAD in paediatric patients and patients with CHD has been reported [275, 278–281]. The obvious advantage is the ability to discharge these young patients home [282–286].\n\n11.2 Small children—system selection\nDevice selection in children and patients suffering from CHD (see section below) differs significantly from that in adults with anatomically normal hearts and also differs substantially among paediatric groups depending on age and the type of CHD of the patient [275, 287, 288]. The Berlin Heart EXCOR® Paediatric VAD is currently the only VAD specifically designed and approved for the paediatric population in the USA, Europe and Canada.\nIn paediatric patients with a body surface area \u003e1.2 m2 requiring MCS, the use of an implantable CF-LVAD is feasible because results are non-inferior to those with extracorporeal devices [275, 289, 290], and discharge from the hospital is possible, resulting in a better quality of life [275, 277, 284, 285, 290]. In adults, CF-VADs have improved survival and greater freedom from stroke and device failure compared with pulsatile devices [147]. This result seems to be true also for paediatric patients with a body surface area \u003e1.2 m2 and without CHD [275, 277, 279, 290].\n\n11.3 Single ventricle—Fontan haemodynamics\nApproximately 5–10% of children born with CHD suffer from an underdeveloped LV or RV, leading to single ventricle physiology. Large studies on the use of MCS in patients with a single ventricle are lacking. Only case reports or small case series have been published, and they report high mortality rates [283, 291, 292]. However, implantation of VADs in various locations seems to be feasible.\nThe feasibility of VAD support for Glenn circulation has been reported with mixed results [283, 292, 293]. After the Fontan circulation has been created, there are 2 possibilities of failure: systemic ventricular failure or failure at the level of the cavopulmonary connection. Currently available VADs are designed to support the failing ventricle. Nevertheless, available devices have been used for cavopulmonary support in patients with failing Fontan circulation [294, 295]. Others use clinically available VADs as a bridge to transplant [296–299]. For patients with failing Fontan circulation, TAH might be a viable option [300]. In cases of failing Fontan circulation and ventricular failure, the BiVAD remains an option but requires revision of the Fontan pathway to allow the separation of the systemic venous and pulmonary circulations, which can be very demanding.\n\n11.4 Total artificial heart\nA certain percentage of patients require biventricular support with either BiVAD placement or implantation of a TAH. The 70-cc TAH (SynCardia Systems Inc., Tucson, AZ, USA) is currently the only Food and Drug Administration (FDA)-approved and Conformité Européenne (CE)-marked TAH licensed for bridge to transplant or destination therapy. However, this device is limited to patients with a larger chest cavity with adequate intrathoracic space to accommodate this device. The 50 cc-TAH (currently under investigation for FDA approval) is more appropriate for use in smaller patients, especially in complex cases who have had limited clinical options such as failing Fontan circulation [300]. Unsurprisingly, reported outcomes in patients ≤21 years supported with a TAH seem to be inferior to LVAD-only implantation [301].\n\n11.5 Special cases\nBesides the ‘single ventricle physiologies’, CHD includes a wide spectrum of cardiac anatomical configurations, including surgically corrected transposition of the great arteries using the atrial switch procedure (Senning or Mustard operation) at infancy/childhood or patients with corrected congenital transposition of the great arteries. VAD placement in these patients is possible, and some patients will benefit from VAD support [275, 302–307]. However, limited data make standardized recommendations impossible. Each case has to be discussed individually, preferably by a dedicated heart team. Adult CHD and non-adult CHD patients supported by LVADs demonstrate similar survival regardless of cardiac anatomy [275]."}

{"project":"0_colil","denotations":[{"id":"31100109-28365175-7626","span":{"begin":306,"end":309},"obj":"28365175"},{"id":"31100109-30184070-7627","span":{"begin":424,"end":427},"obj":"30184070"},{"id":"31100109-28365175-7628","span":{"begin":734,"end":737},"obj":"28365175"},{"id":"31100109-28125462-7629","span":{"begin":743,"end":746},"obj":"28125462"},{"id":"31100109-26720740-7630","span":{"begin":830,"end":833},"obj":"26720740"},{"id":"31100109-28365175-7631","span":{"begin":1137,"end":1140},"obj":"28365175"},{"id":"31100109-25454394-7632","span":{"begin":1142,"end":1145},"obj":"25454394"},{"id":"31100109-28259596-7633","span":{"begin":1147,"end":1150},"obj":"28259596"},{"id":"31100109-28365175-7634","span":{"begin":1502,"end":1505},"obj":"28365175"},{"id":"31100109-24002006-7635","span":{"begin":1507,"end":1510},"obj":"24002006"},{"id":"31100109-27009673-7636","span":{"begin":1512,"end":1515},"obj":"27009673"},{"id":"31100109-28365175-7637","span":{"begin":1602,"end":1605},"obj":"28365175"},{"id":"31100109-25612114-7638","span":{"begin":1612,"end":1615},"obj":"25612114"},{"id":"31100109-26776864-7639","span":{"begin":1617,"end":1620},"obj":"26776864"},{"id":"31100109-27009673-7640","span":{"begin":1622,"end":1625},"obj":"27009673"},{"id":"31100109-19920051-7641","span":{"begin":1754,"end":1757},"obj":"19920051"},{"id":"31100109-28365175-7642","span":{"begin":1868,"end":1871},"obj":"28365175"},{"id":"31100109-27056612-7643","span":{"begin":1878,"end":1881},"obj":"27056612"},{"id":"31100109-27009673-7644","span":{"begin":1883,"end":1886},"obj":"27009673"},{"id":"31100109-27836026-7645","span":{"begin":2238,"end":2241},"obj":"27836026"},{"id":"31100109-28486624-7646","span":{"begin":2243,"end":2246},"obj":"28486624"},{"id":"31100109-24290716-7647","span":{"begin":2248,"end":2251},"obj":"24290716"},{"id":"31100109-27836026-7648","span":{"begin":2418,"end":2421},"obj":"27836026"},{"id":"31100109-24290716-7649","span":{"begin":2423,"end":2426},"obj":"24290716"},{"id":"31100109-19332269-7650","span":{"begin":2428,"end":2431},"obj":"19332269"},{"id":"31100109-23411780-7651","span":{"begin":2795,"end":2798},"obj":"23411780"},{"id":"31100109-22421403-7652","span":{"begin":2800,"end":2803},"obj":"22421403"},{"id":"31100109-22336753-7653","span":{"begin":2874,"end":2877},"obj":"22336753"},{"id":"31100109-28007058-7654","span":{"begin":2956,"end":2959},"obj":"28007058"},{"id":"31100109-28007058-7655","span":{"begin":3917,"end":3920},"obj":"28007058"},{"id":"31100109-28009714-7656","span":{"begin":4047,"end":4050},"obj":"28009714"},{"id":"31100109-28365175-7657","span":{"begin":4507,"end":4510},"obj":"28365175"},{"id":"31100109-28781147-7658","span":{"begin":4516,"end":4519},"obj":"28781147"},{"id":"31100109-28365175-7659","span":{"begin":4788,"end":4791},"obj":"28365175"}],"text":"11. PAEDIATRIC OPERATIVE TECHNIQUES\n\n11.1 Introduction\nThe success rate of bridging children with MCS to a transplant or recovery using pulsatile or CF devices has improved with time. In the latest PEDIMACS report, an 84% 6-month survival rate on devices was reported with a transplant rate of nearly 50% [275], whereas the first Paedi-EUROMACS report shows a 6-month survival of 81% and a transplant rate of more than 50% [276]. Paediatric data on intracorporeal devices from EUROMACS demonstrated an on-device survival rate of 89% at 12 months [277]. Originally, the MCS devices used were mainly paracorporeal devices. More recently, an increase in the use of CF-LVAD in paediatric patients and patients with CHD has been reported [275, 278–281]. The obvious advantage is the ability to discharge these young patients home [282–286].\n\n11.2 Small children—system selection\nDevice selection in children and patients suffering from CHD (see section below) differs significantly from that in adults with anatomically normal hearts and also differs substantially among paediatric groups depending on age and the type of CHD of the patient [275, 287, 288]. The Berlin Heart EXCOR® Paediatric VAD is currently the only VAD specifically designed and approved for the paediatric population in the USA, Europe and Canada.\nIn paediatric patients with a body surface area \u003e1.2 m2 requiring MCS, the use of an implantable CF-LVAD is feasible because results are non-inferior to those with extracorporeal devices [275, 289, 290], and discharge from the hospital is possible, resulting in a better quality of life [275, 277, 284, 285, 290]. In adults, CF-VADs have improved survival and greater freedom from stroke and device failure compared with pulsatile devices [147]. This result seems to be true also for paediatric patients with a body surface area \u003e1.2 m2 and without CHD [275, 277, 279, 290].\n\n11.3 Single ventricle—Fontan haemodynamics\nApproximately 5–10% of children born with CHD suffer from an underdeveloped LV or RV, leading to single ventricle physiology. Large studies on the use of MCS in patients with a single ventricle are lacking. Only case reports or small case series have been published, and they report high mortality rates [283, 291, 292]. However, implantation of VADs in various locations seems to be feasible.\nThe feasibility of VAD support for Glenn circulation has been reported with mixed results [283, 292, 293]. After the Fontan circulation has been created, there are 2 possibilities of failure: systemic ventricular failure or failure at the level of the cavopulmonary connection. Currently available VADs are designed to support the failing ventricle. Nevertheless, available devices have been used for cavopulmonary support in patients with failing Fontan circulation [294, 295]. Others use clinically available VADs as a bridge to transplant [296–299]. For patients with failing Fontan circulation, TAH might be a viable option [300]. In cases of failing Fontan circulation and ventricular failure, the BiVAD remains an option but requires revision of the Fontan pathway to allow the separation of the systemic venous and pulmonary circulations, which can be very demanding.\n\n11.4 Total artificial heart\nA certain percentage of patients require biventricular support with either BiVAD placement or implantation of a TAH. The 70-cc TAH (SynCardia Systems Inc., Tucson, AZ, USA) is currently the only Food and Drug Administration (FDA)-approved and Conformité Européenne (CE)-marked TAH licensed for bridge to transplant or destination therapy. However, this device is limited to patients with a larger chest cavity with adequate intrathoracic space to accommodate this device. The 50 cc-TAH (currently under investigation for FDA approval) is more appropriate for use in smaller patients, especially in complex cases who have had limited clinical options such as failing Fontan circulation [300]. Unsurprisingly, reported outcomes in patients ≤21 years supported with a TAH seem to be inferior to LVAD-only implantation [301].\n\n11.5 Special cases\nBesides the ‘single ventricle physiologies’, CHD includes a wide spectrum of cardiac anatomical configurations, including surgically corrected transposition of the great arteries using the atrial switch procedure (Senning or Mustard operation) at infancy/childhood or patients with corrected congenital transposition of the great arteries. VAD placement in these patients is possible, and some patients will benefit from VAD support [275, 302–307]. However, limited data make standardized recommendations impossible. Each case has to be discussed individually, preferably by a dedicated heart team. Adult CHD and non-adult CHD patients supported by LVADs demonstrate similar survival regardless of cardiac anatomy [275]."}

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PAEDIATRIC OPERATIVE TECHNIQUES\n\n11.1 Introduction\nThe success rate of bridging children with MCS to a transplant or recovery using pulsatile or CF devices has improved with time. In the latest PEDIMACS report, an 84% 6-month survival rate on devices was reported with a transplant rate of nearly 50% [275], whereas the first Paedi-EUROMACS report shows a 6-month survival of 81% and a transplant rate of more than 50% [276]. Paediatric data on intracorporeal devices from EUROMACS demonstrated an on-device survival rate of 89% at 12 months [277]. Originally, the MCS devices used were mainly paracorporeal devices. More recently, an increase in the use of CF-LVAD in paediatric patients and patients with CHD has been reported [275, 278–281]. The obvious advantage is the ability to discharge these young patients home [282–286].\n\n11.2 Small children—system selection\nDevice selection in children and patients suffering from CHD (see section below) differs significantly from that in adults with anatomically normal hearts and also differs substantially among paediatric groups depending on age and the type of CHD of the patient [275, 287, 288]. The Berlin Heart EXCOR® Paediatric VAD is currently the only VAD specifically designed and approved for the paediatric population in the USA, Europe and Canada.\nIn paediatric patients with a body surface area \u003e1.2 m2 requiring MCS, the use of an implantable CF-LVAD is feasible because results are non-inferior to those with extracorporeal devices [275, 289, 290], and discharge from the hospital is possible, resulting in a better quality of life [275, 277, 284, 285, 290]. In adults, CF-VADs have improved survival and greater freedom from stroke and device failure compared with pulsatile devices [147]. This result seems to be true also for paediatric patients with a body surface area \u003e1.2 m2 and without CHD [275, 277, 279, 290].\n\n11.3 Single ventricle—Fontan haemodynamics\nApproximately 5–10% of children born with CHD suffer from an underdeveloped LV or RV, leading to single ventricle physiology. Large studies on the use of MCS in patients with a single ventricle are lacking. Only case reports or small case series have been published, and they report high mortality rates [283, 291, 292]. However, implantation of VADs in various locations seems to be feasible.\nThe feasibility of VAD support for Glenn circulation has been reported with mixed results [283, 292, 293]. After the Fontan circulation has been created, there are 2 possibilities of failure: systemic ventricular failure or failure at the level of the cavopulmonary connection. Currently available VADs are designed to support the failing ventricle. Nevertheless, available devices have been used for cavopulmonary support in patients with failing Fontan circulation [294, 295]. Others use clinically available VADs as a bridge to transplant [296–299]. For patients with failing Fontan circulation, TAH might be a viable option [300]. In cases of failing Fontan circulation and ventricular failure, the BiVAD remains an option but requires revision of the Fontan pathway to allow the separation of the systemic venous and pulmonary circulations, which can be very demanding.\n\n11.4 Total artificial heart\nA certain percentage of patients require biventricular support with either BiVAD placement or implantation of a TAH. The 70-cc TAH (SynCardia Systems Inc., Tucson, AZ, USA) is currently the only Food and Drug Administration (FDA)-approved and Conformité Européenne (CE)-marked TAH licensed for bridge to transplant or destination therapy. However, this device is limited to patients with a larger chest cavity with adequate intrathoracic space to accommodate this device. The 50 cc-TAH (currently under investigation for FDA approval) is more appropriate for use in smaller patients, especially in complex cases who have had limited clinical options such as failing Fontan circulation [300]. Unsurprisingly, reported outcomes in patients ≤21 years supported with a TAH seem to be inferior to LVAD-only implantation [301].\n\n11.5 Special cases\nBesides the ‘single ventricle physiologies’, CHD includes a wide spectrum of cardiac anatomical configurations, including surgically corrected transposition of the great arteries using the atrial switch procedure (Senning or Mustard operation) at infancy/childhood or patients with corrected congenital transposition of the great arteries. VAD placement in these patients is possible, and some patients will benefit from VAD support [275, 302–307]. However, limited data make standardized recommendations impossible. Each case has to be discussed individually, preferably by a dedicated heart team. Adult CHD and non-adult CHD patients supported by LVADs demonstrate similar survival regardless of cardiac anatomy [275]."}