A 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].