Abstract 
This review examines the use of the HeartMate 3 (HM3) left ventricular assist device in children, small adults, and patients with congenital heart disease, populations for whom the device was not originally designed but has become the only FDA-approved intracorporeal option since its 2020 pediatric approval. The authors detail the physiologic principles unique to smaller patients, including power-flow dynamics, pulsatility index interpretation, and load sensitivity from HQ curves, and explain how these factors demand closer monitoring than in typical adult use. Drawing on ACTION network data, including outcomes from a 170-patient pediatric cohort with 92.4% device survival, the review outlines patient selection criteria (favoring left ventricular dimensions over body size alone), surgical adaptations for smaller anatomy, and population-specific management strategies for congenital heart disease patients, Fontan circulation physiology, and children with muscular dystrophy. The authors conclude that successful HM3 implantation in these complex populations requires individualized anticoagulation, multidisciplinary perioperative planning, and coordinated rehabilitation and psychosocial support, and they call for continued collaborative data sharing and development of purpose-built pediatric devices to further improve long-term outcomes.
This ACTION study was published online ahead of print on August 05, 2026 in the ASAIO Journal. Congratulations to the authors:
- Tanya Perry
- Jon Edelson
- Anna Joong
- Chet Villa
- Jenna Murray
- Michael Monge
- Shahnawaz Amdani
- Lydia K. Wright
- Angela Lorts
CITATION
Perry, T., Edelson, J., Joong, A., Villa, C., Murray, J., Monge, M., Amdani, S., Wright, L. K., & Lorts, A. (2026). HeartMate 3 in Pediatric and Complex Populations: Physiologic Rationale, Patient Selection, and Management Strategies. ASAIO Journal. https://doi.org/10.1097/MAT.0000000000002797
