66 Chronic Mechanical Circulatory Support Joseph W Rossano, Kyle W Riggs, Kelley D Miller, David L.S Morales Introduction The use of long-term mechanical circulatory support (MCS), predominately in the form of ventricular assist devices (VADs), has undergone a major transformation in the past 15 years In the early 2000s, device use was uncommon Support was typically for short duration, in patients with cardiogenic shock, and pediatric-specific device use, especially in the United States, was exceptionally rare In the initial report on VADs from the Pediatric Heart Transplant Study database, covering children listed for heart transplantation from 1993 to 2003, only 4% of patients were supported with a VAD and only one Berlin Heart EXCOR VAD was used.1 This is in contrast to the current state where nearly 50% of pediatric patients with dilated cardiomyopathy (DCM) in the International Society for Heart and Lung Transplantation Registry are bridged to transplant with a VAD.2 In most pediatric transplant centers, VADs would currently be considered a standard part of advanced heart failure management, predominately being used as a bridge to transplant ... Support was typically for short duration, in patients with cardiogenic shock, and pediatric- specific device use, especially in the United States, was exceptionally rare In the initial report on VADs from the Pediatric Heart Transplant Study database, covering children listed for heart... the current state where nearly 50% of pediatric patients with dilated cardiomyopathy (DCM) in the International Society for Heart and Lung Transplantation Registry are bridged to transplant with a VAD.2 In most pediatric transplant centers, VADs would currently be considered a standard part