A ventricular assist device is a mechanical pump used to support failing heart function when medical therapies have been exhausted. The need for mechanical circulatory support arises when medical therapy has been exhausted in the setting of heart failure. The purpose of a ventricular assist device such as the Berlin Heart EXCOR is to assume or augment ventricular function and restore cardiac output and adequate perfusion to end-organs. The Berlin Heart EXCOR (Berlin Heart GmbH) is the only Food and Drug Administration–approved device for long-term support of younger children with low cardiac output syndrome, and it can be used for right, left, or biventricular support. This chapter details the assessment and perioperative management of a patient receiving left ventricular support with a Berlin Heart.

This chapter provides an excellent and in-depth discussion on the complexities associated with caring for children with ventricular assist device support. The author provides a thorough analysis of the available support devices in children based on the patients’ indication for support. perioperative management algorithms for patients supported by the continuous flow devices and Berlin devices are suggested. The perioperative approach for these patients is reviewed in detail with respect to VAD/anesthesia interaction.