The majority of patients who undergo pediatric ventricular assist device implantation or heart transplant are expected to survive to adulthood. However, there is limited research into what their neurodevelopmental and neurocognitive trajectories will be. This narrative mini review summarizes the literature available, demonstrating the significant burden of neurodevelopmental and neurocognitive difficulties in survivors, and highlights the importance of improving anticoagulation and developmental care in this population aiming for patients to reach their full potential. There is ongoing need for further research, and collaboratives such as the Advanced Cardiac Therapies Improving Outcomes Network can play an integral role in facilitating our understanding of the risk factors and long-term outcomes in this complex and high-risk patient population.

Background Ex-situ heart perfusion (ESHP) improves donor heart preservation via provision of a semi-physiologic, controlled environment. Optimizing preservation capacity through ESHP is of great interest to expand the donor pool and overcome logistical challenges. However, devices are currently untailored to pediatric donor hearts. We sought to evaluate subnormothermic ESHP (sESPH) in comparison to static cold storage (SCS). Methods Juvenile Yorkshire pig hearts (∼20 kg) were procured and subject to 10 hours of sESHP (n = 6) or 6 hours of SCS in modified Del Nido solution (n = 5), then transplanted orthotopically into weight-matched recipients. Following 2 hours of reperfusion, echocardiography was conducted before pigs were euthanized and samples of the ventricles were collected for analysis. Immunofluorescence staining for vascular inflammation markers VCAM-1, ICAM-1, and E-selectin was conducted. Hematoxylin and eosin staining of the ventricles was conducted and reviewed by a pathologist blinded to the experimental groups and scored for contraction bands, edema formation, inflammation, and hemorrhage. Results By echocardiography, hearts from both groups regained acceptable biventricular functionality, with no difference in left ventricular ejection fraction and shortening fraction between groups (p > 0.05). No differences in histological damage scores were found between groups (p > 0.05). Immunofluorescence staining showed qualitatively lessened expression of all markers in the sESPH group. Conclusions sESPH appears to prolong out-of-body time of pediatric donor hearts, with non-inferior tissue and functional preservation compared to SCS. sESHP may lessen inflammatory burden over the course of the preservation period.

BACKGROUND:The majority of patients who undergo ventricular assist device (VAD) implant in childhood survive to adulthood. This study examined the neurodevelopmental trajectory post VAD and determined factors associated with non-optimal outcome. METHODS:Patients implanted with a VAD aged < 6 years between 01/2006 and 12/2020, who underwent assessment at 4.5-7-years of age (and > 6 months post decannulation) with the Complex Pediatric Therapies Follow-up Program were included in a prospective-inception-cohort study. Optimal neurodevelopmental outcome was defined as scores of ≥ 80 on the Wechsler Preschool and Primary Scales of Intelligence, the Beery-Buktenica Developmental Test of Visual-Motor Integration and on the Adaptive Behavior Assessment System, in the absence of cerebral palsy, permanent hearing loss, visual impairment, or seizure disorder. Firth multiple regression analysis was used to determine independent factors associated with non-optimal outcome. RESULTS:A total of 74 patients underwent VAD implant at age < 6 years with neurodevelopmental assessments available for 48/51 patients who survived to testing. Median age at implant was 0.63 years (IQR 0.20, 2.74), 37.5% were female and 39.6% had congenital heart disease. Optimal outcome occurred in 33% of patients. Optimal outcome was associated with female sex [OR 8.03 (95% CI 1.69-56.64) p = 0.007] and implant between 2015 and 2020 [OR 6.59 (95% CI 1.42-42.62) p = 0.016]. Neurological insult sustained pre-post-VAD [OR 0.10 (95% CI 0.01-0.63) p = 0.01] was associated with a non-optimal outcome. CONCLUSION:Optimal outcome was present in one-third of patients. Protective factors were female sex and implant between 2015 and 2020. Neurological insult was associated with a non-optimal outcome.

Cardiac recovery following durable left ventricular assist device (LVAD) implantation is the ideal outcome for heart failure patients. Traditionally, the durable LVAD has required explantation. We describe our single-center experience with LVAD decommissioning. LVAD decommissioning involved making a sternotomy or sub-xiphoid incision, ligating the outflow graft, and removal of the driveline by transecting the driveline inside and outside of the chest. Six patients underwent durable LVAD decommissioning from 2017–2024. One patient had a HeartWare device, three patients had a HeartMate II, and two patients had a HeartMate 3. All patients were successfully decommissioned and discharged without mechanical circulatory support.

Avoiding grafts with ischemic time (IT) >6 hours continues to be advised in pediatric heart transplant (HTx). We sought to evaluate the association between IT and clinical outcomes in a geographically remote center. This was a retrospective single-center analysis of patients transplanted between January 1995 and December 2020. Baseline characteristics and post-HTx outcomes were compared across 3 IT groups (<4.5 hours, 4.5-6 hours, and >6 hours) with results reported in that order. Cox proportional hazard modeling was used to determine factors associated with graft failure. Of the 188 patients, 56.4% were men, the median age was 3.0 years (interquartile range, 0.6, 10.2 years), and 46.3% had congenital heart disease. IT was evenly distributed among the cohort (37.2% vs 31.4% vs 31.4%). There were no differences in early post-HTx morbidity, including primary graft dysfunction (2.9% vs 1.7% vs 5.3%, P = .5). Compared with IT <4.5 hours, longer IT was not associated with graft failure (IT 4.5-6 hours: hazard ratio, 1.10 [0.50-2.39]; P = .810 and [IT >6 hours: hazard ratio 1.10 {0.52-2.35}]; P = .797). In our population, IT was not an independent risk factor for post-HTx morbidity or graft failure. Use of a modified del Nido preservation solution and experience with prolonged IT donors may have contributed to our outcomes.

Obesity factors into hypertrophic cardiomyopathy (HCM)-related risk as a disease modifying environmental factor. Behaviours such as diet and sleep are seldom reported upon in children with HCM. It was our aim to report on these factors in this population. A multicenter cross-sectional study recruited children and teens with HCM aged 10–19 years old from 10 Canadian pediatric care sites. Patient demographics were obtained from review of medical charts. Participants completed the Healthy Hearts Survey, involving 92 questions related to family health history, personal health, smoking, nutrition, and physical or sedentary activity. A cohort of n = 56 patients with median (IQR) age of 15.5 (13.8–16.8) years were enrolled. Over half (53.6

Background Little is known about patients who are referred for ventricular assist device (VAD) therapy but not implanted. The purpose of this study is to describe their outcomes at 1-year post initial consultation. Methods Retrospective analysis for patients referred to our VAD services between 01/2019 and 12/2023. Outcomes were reported at 30 days and 1-year post-consult. Patients who died, were too unwell for VAD or required extracorporeal membrane oxygenation (ECMO) within 30 days of consultation were considered acute referrals. Multivariate logistic regression analysis was used to determine risk factors for being an acute referral. Results There were 128 patients included, with median age at referral 2.7 years (IQR 0.3, 0.9), 50.8% being male, and 52.3% of patients having congenital heart disease (CHD). The primary indication for VAD consult was due to the patient undergoing a transplant evaluation. At 30 days 31% (n = 41) were considered acute referrals, with 28.1% (n = 36) receiving ECMO, 3.1% (n = 4) being too unwell for VAD, and 0.8% (n = 1) patients dying. Patients who were acute referrals and had not received VAD therapy or transplant had worse 1-year survival (p < 0.001) then elective referrals, with the highest risk for mortality being early in the course. Diagnosis of biventricular CHD, other (non-CHD, non-cardiomyopathy) or absence of co-morbidities were independent factors associated with being an acute referral. Conclusion Of patients referred to the VAD service, one-third were considered acute referrals. Patients who were acute referrals had increased 1-year mortality than those who were elective referrals. Factors associated with being an acute referral included diagnosis of biventricular CHD or other and no co-morbidities.

Background Literature reporting neurodevelopmental outcomes for patients who undergo ventricular assist device (VAD) therapy is limited to posttransplant cohorts. This study aims to determine the prevalence of optimal neurodevelopmental outcome and factors associated with nonoptimal outcome in patients implanted with a VAD at ≤15 months of age. Methods Patients followed by the Complex Pediatric Therapies Follow‐Up Program were included in a prospective‐inception cohort study if born between January 2006 and December 2022 and implanted with a VAD at ≤15 months of age. A modified optimal neurodevelopmental outcome was defined as scores of ≥80 on the Bayley Scales of Infant and Toddler Development and on the Adaptive Behavior Assessment System, and in the absence of cerebral palsy, permanent hearing loss, visual impairment, or seizure disorder. Firth multiple regression analysis was used to determine independent factors associated with nonoptimal outcome. Results A total of 56 patients underwent VAD implant at ≤15 months with neurodevelopmental assessments available for 39/40 patients who survived to 2 years. The mean age of VAD implant was 5.45 (SD 3.99) months, 69.2% were male, and 38.5% had congenital heart disease. Optimal neurodevelopmental outcome was seen in 25.6% of patients. Neurological insult (OR, 12.34 [95% CI, 1.29–1660.36], P=0.026) was the only independent factor identified associated with nonoptimal outcome. Conclusions Optimal outcome was demonstrated in one quarter of patients who had a VAD at ≤15 months of age and underwent neurodevelopmental testing at 2 years of age. A potentially modifiable factor of neurological insult was demonstrated as being independently associated with nonoptimal outcome.

Background:The HeartMate 3 (HM3) has become among the most widely utilized durable left ventricular (LV) assist devices (LVAD) owing to reduced rates of pump thrombosis, bleeding, and stroke. One limitation of the HM3 is its large size, which poses a challenge for implantation in smaller LVs. Herein, we describe a novel technique for durable LVAD implantation in patients with a small LV. Methods:Patients who underwent durable LVAD implantation from January 2020 to August 2024 were included in this study. The modified technique involved excision of the mitral valve (MV) and associated apparatus to create room for the LVAD inflow. The primary outcome was mortality, and secondary outcomes included rates of postoperative complications and hemodynamic parameters. Patient follow-up was until September 2024. Results:Eleven patients were included in this study. All patients received an HM3. The median preoperative LV end-diastolic diameter was 5.1 cm. The median total time on LVAD was 149 days, and overall mortality was 27.2% occurring a median of 204 days post-LVAD implantation. Four patients (36.4%) underwent heart transplantation and 4 (36.4%) were alive on LVAD at last follow-up. Proportions of morbidity included readmission for heart failure (n = 2, 18.2%), cerebrovascular accident (n = 2, 18.2%), and pump thrombosis (n = 0). Conclusions:The small LV has been a significant challenge for durable LVAD insertion and is often considered a contraindication. A modified approach to LVAD insertion, including excision of the MV and associated apparatus and alignment of the LVAD inflow cannula with the MV orifice, allows for LVAD implantation in patients with a small LV.

Background Pediatric hypertrophic cardiomyopathy (HCM) is associated with sudden cardiac death, often resulting in restriction of strenuous physical activity. High levels of inactivity and a rise in youth obesity may increase risk of poor cardiovascular (CV) health in these patients. We aim to compare the CV disease risk profile of pediatric patients with HCM to Canadian youth. Methods Patients with HCM (10-19 years) were recruited from 10 pediatric cardiac centers in Canada. CV disease risk profile was determined using the Healthy Hearts School Program questionnaire and Cardiovascular Health in Ambulatory Care Research Team (CANHEART) health index. Poisson regressions were used to assess associations between CV disease risk profile of pediatric patients with HCM, and overall CANHEART health score. Results 56 subjects were enrolled [71% male, median age 15.5 years (IQR 13.8–16.8), median BMI 23.3 (IQR 19.5–27.7)]. Results of the CANHEART health index revealed 89% of HCM participants never tried smoking, 52% had a healthy BMI, 39% consumed ≥5 fruits/vegetables per day, and 50% engaged in ≥60 minutes of walking or 20 minutes of running/jogging per day. When CANHEART intermediate and poor health index scores were combined, similar proportions were obtained for each group (HCM 82.1% versus Canadian youth 83.4%; p=0.724). Conclusions Many pediatric patients with HCM in Canada have intermediate or poor CV health as determined by the CANHEART health score, with high rates of obesity and low physical activity levels driving these trends. Interventions should be developed to promote positive CV health behaviours among patients with HCM.

Background Hypertrophic cardiomyopathy is a burdensome condition that inflicts both physical and psychological impairment on those with the disease, negatively impacting health‐related quality of life (HRQoL). Given the abundance of evidence suggesting a role of physical activity (PA) in modulating HRQoL in healthy populations of children, we sought to determine the relationship between HRQoL and PA in children diagnosed with hypertrophic cardiomyopathy. Methods and Results A multicenter prospective observational cohort study was conducted, with patients with hypertrophic cardiomyopathy aged 10 to 19 years being provided a wrist‐worn activity tracker (Fitbit Charge HR) to wear for 14 days. Patients self‐reported on Pediatric Quality of Life 4.0 quality of life inventory items, which were associated with PA metrics following covariate adjustment using linear regression. A total of 56 participants were recruited to the study. The median age at enrollment was 15.5 years (interquartile range, 13.8–16.8), and 16 out of 56 (29%) of the cohort were girls. The cohort reported decreased metrics of physical, psychosocial, and total summary scores compared with health reference populations, with scores comparable with that of published populations with chronic disease. Increased physical HRQoL scores were significantly associated with increased daily steps taken, distance traveled, and flights of stairs climbed. Conclusions These results show that impaired PA correlates with reduced HRQoL in children with hypertrophic cardiomyopathy, suggesting PA may partially mediate HRQoL in this population.

Background Pediatric hypertrophic cardiomyopathy (HCM) can increase risk of sudden cardiac death during physical activity (PA). As a result, patients are advised to avoid strenuous exercise, leading to reduced PA levels and increased body mass index, raising concerns for long-term cardiovascular health in this population. Our objective was to assess PA levels in children with HCM using subjective and objective reporting measures. Factors and/or barriers influencing physical activity levels were also evaluated. Methods 56 participants with HCM (10–19 years) were recruited from 10 pedatric cardiac centers between May 2019 and January 2023. PA was assessed using a Fitbit activity tracker for 14 days and two-self reported questionnaires: Healthy Heart School Program questionnaire and Habitual Activity Estimation Scale (HAES). The Self-Efficacy for Exercise Scale (SEE) evaluated factors influencing activity. Spearman correlation assessed relationships between Fitbit and HAES data. Results Of the 56 participants (71% male, median age 15.5 years), only 12.5% met the recommended daily step count of >12,500 and 4% reported 20 minutes of moderate-to-vigorous PA 7 days a week. Fitbit average daily steps positively correlated with HAES activity levels, although was not statistically significant. Perceived barriers to activity included pain and fatigue. Conclusions Pediatric participants with HCM engage in low PA, possibly due to exercise restrictions and perceived barriers. This raises concerns for long-term cardiovascular disease, highlighting the need for safe, evidence-based exercise guidelines in this population.

Background: Ventricular assist devices (VADs) are becoming a standard part of advanced heart failure therapy in children. They are utilized mostly as a bridge to transplant (HTx) but also can be used for recovery. While information on complications during VAD therapy is available, there is limited information on long term outcomes in this patient population, specifically neurodevelopmental outcomes. Research Question: To determine the prevalence of ‘optimal neurodevelopmental outcomes’ in 2-year-old children previously treated with a VAD. Methods: Patients were followed through the Complex Pediatric Therapies Follow-Up Program. This study included patients born between January 2006 and December 2022, implanted with a VAD at < 15 months of age and surviving to 2 years of age. A modified optimal neurodevelopmental outcome was defined as the Cognitive, Language and Motor Composite Scores on the Bayley Scales of Infant and Toddler Development and the Adaptive Behaviour Assessment System - General Adaptive Composite Score ≥ 80 each, with the absence of cerebral palsy, permanent hearing loss, visual impairment, or seizure disorder. Results: There were 56 patients who met inclusion criteria with 40 patients surviving to the age of 2 years. Of the survivors, the median (IQR) gestational age (GA) was 38 [37, 39] (4 [7.1%] <37completed weeks GA), 70% were male and 7.5% had a chromosomal abnormality. The median age of implant was 0.39 [0.19, 0.64], years and weight 5.8Kg [4.1, 7.5]. The majority of patients did not have congenital heart disease (62.5%). The most common implant strategy was a left VAD (87.5%) with paracorporeal continuous support (42.5%). Most patients were supported with ECMO (55%) pre- or post-VAD implant. One-third of the cohort had a neurological insult either pre- or post-implant. Total duration of support was a median 32 days [8, 93] with 65% undergoing HTx and 35% decannulated for recovery. Thirty-nine patients underwent full neurodevelopmental testing at 2 years of age with only 25.6% (n=19) of the patients classified as having an optimal neurodevelopmental outcome with 43.6% (n=17) having a Bayley cognitive score <80. Conclusion: Optimal neurodevelopmental outcome at 2 years of age was present in only one-quarter of children following a treatment pathway that included VAD therapy in infancy. Important next steps will be to identify associations, including modifiable risk factors, for optimal neurodevelopmental outcomes.

Objective: Pediatric patients on ventricular assist devices (VAD) are at risk of thromboembolic (TE) complications. Our objective was to identify factors associated with TE events, including the role of initial anticoagulation strategy and device type in the pediatric VAD population. Methods: This was a retrospective, single-center review (2005-2022) of children who were implanted with paracorporeal pulsatile (PP), paracorporeal continuous (PC), or a combination of devices. Patient- and device-related factors were collected. Kaplan-Meier survival analysis was performed to determine freedom from TE. Cox proportional hazard analysis was conducted to look for factors associated with TE events. Results: Ninety-five fi ve patients included with a median age of 0.9 years (interquartile range, 0.3, 5.4); median weight of 8.4 kg (interquartile range, 4.5, 17.8), and 63.2% with noncongenital heart disease. Device breakdown included 47.4% PC, 24.2% PP, and 23.2% combination of devices. Initial anticoagulation was either heparin (61.5%) or bivalirudin (38.5%). In Kaplan-Meier analysis, unadjusted freedom from a TE event was significantly greater in those who received bivalirudin as their initial anticoagulation strategy (P = .02) and PP VADs (P = .02). In multivariate analysis, initial anticoagulation strategy with bivalirudin (hazard ratio, 0.30; 95% % confidence interval, 0.12-0.75, P = .01) was associated with a reduced hazard of TE events, whereas PC device strategy was found to be associated with an increased hazard (hazard ratio, 2.78; 95% % confidence fi dence interval, 1.12-6.88, P = .03). Conclusions: This study suggests that PC device strategy and heparin as an initial anticoagulation strategy are associated with increased hazard of TE events. Further research is required to understand the interaction between device type and initial anticoagulation strategy. (JTCVS Open 2024;20:132-40)

Background Primary graft failure (PGF) is a leading cause of early morbidity and mortality after heart transplantation (HTx). PGF is secondary to graft ischemia and ischemia-reperfusion injuries to the cardiomyocytes and vasculature of the donor heart after transplantation. Longer-term outcomes after PGF are not well studied. Methods Patients with a HTx (01/01/10-30/06/22) were identified using the PHTS registry. PGF was defined as death, retransplantation or need for mechanical circulatory support within 72 hours of HTx. Kaplan-Meier analysis and Cox proportional hazard modelling were utilized. Results Of the 4982 patients with a primary HTx, 5.4% (n=269) met criteria for PGF. Patients with PGF were younger, with higher proportion of congenital heart disease, longer cardiopulmonary bypass and ischemic times (IT), and more likely to be on ECMO or ventilator at HTx (all p<0.0001, IT p=0.0006). PGF resulted in lower overall survival (1-yr: 54% vs. 94%, p<0.001). This remained true when conditional survival was examined at 30- and 90-days but not at 1-year (p=0.1143). Freedom from rejection did not differ between the groups at overall or conditional on 30-days but was slightly higher for those with PGF at 90 and 365 days. There was no difference in freedom from coronary allograft vasculopathy (CAV). PGF was an independent predictor of overall graft loss (HR 4.7, p<0.0001) and conditional survival to 30-days (HR 2.47, p<0.0001) and 90-days (HR 1.6, p=0.012) but not beyond one year. Conclusion Severe PGF is an independent predictor of early mortality post-HTx but subsequently does not further impact long-term survival, overall risk of rejection, or CAV. Understanding the impact of milder forms of PGF on survival and long-term outcomes is still needed. Methods to decrease the risk of PGF, such as alternative preservation and storage techniques, may impact early mortality post-HTx.

BACKGROUND:Ventricular assist devices (VADs) are used to bridge pediatric patients to heart transplantation. Paracorporeal VADs require the placement of cannulas, which can create an environment for infections. We examined cannula infections in pediatric VAD patients and the role of nutritional status.METHODS:This retrospective study (2005-2021) included patients <20 years old on VAD support using Berlin Heart EXCOR® cannulas. Cannula infections were defined by a positive culture and need for antibiotic therapy. Malnutrition was defined using the American Society of Parenteral and Enteral Nutrition guidelines as well as the Michigan MTool.RESULTS:There were 76 patients with a median age at implant of 0.9 years (IQR 0.4, 3.6), 50% male, with 73.7% having non-congenital heart disease. More than one-quarter (26.3%) of patients developed a cannula infection. Higher pre-implant weight (OR = 1.93, p = 0.05), creatinine (OR = 1.02, p = 0.044), and pre-albumin (OR = 15.79, p = 0.025), as well as duration of VAD support (OR = 1.01; p = 0.003) were associated with increased odds of developing a cannula infection. There was no difference in the malnutrition parameters between those with and without an infection.CONCLUSIONS:Further exploration in a larger cohort is needed to see whether these associations remain and if the incorporation of objective measures of nutritional status at the time of infection are predictive.

Introduction: The Berlin Heart EXCOR® is the durable mechanical support of choice for pediatric patients with heart failure refractory to medical management. As per the 6th Annual PEDIMACS report, 1-year mortality on a Berlin Heart is 17.6%, with no deaths due to device malfunction. The most reported adverse events are infection, non-GI bleeding and neurological events. There have been no reported cases in the literature of device malfunction secondary to the cannulas. We report on two cases of device malfunction in pediatric patients supported with the Berlin Heart.

Purpose: Primary graft failure (PGF) is a leading cause of early morbidity and mortality after heart transplant (HTx). It manifests as allograft dysfunction in the absence of other causes. While the impact of PGF on early mortality in pediatrics has been described, it is unclear if PGF also influences long-term survival and post-HTx complications.

Background: Physical activity (PA) is a mainstay for cardiovascular health. However, those with hypertrophic cardiomyopathy (HCM) are often counselled to limit PA due to the potential risk of sudden cardiac death. The emphasis placed on restriction has put this population more susceptible for acquired cardiovascular (CV) risk factors, and poor long-term CV health from physical inactivity. To date, no consensus exists about what is appropriate and safe in terms of exercise for this population. Project Aim: Use a modified Delphi method to gain consensus amongst subject matter experts on a proposed home-based exercise intervention for children 10 to 19 years of age with HCM. Methods: A panel of experts, including pediatric cardiologists, sports cardiologists, exercise physiolologists, obesity experts, and parent/patient representatives met a series of five times to develop a home-based exericse program. The proposed program was converted into a survey and sent out through the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) from October 2023 to June 2024. Utilizing a modified Delphi method, each of the 11 components of the intervention were voted on regarding the degree of agreement by responders. For those who disagreed, they were prompted to provide feedback in order to modify that aspect of the exercise program. The participants were provided with feedback after each round. We aimed for 90% agreement on each component to declare consensus. Results: At total of 49 individuals completed the first round of the survey with 84% identified as a pediatric cardiologists, 75% working in a University center and two-thirds having more than five years of experience. After Round 1 consensus was reached on 3/11 and up to 8/11 after Round 2. The progression to the final home-based exercise protocol is outlined in Table 1. Conclusion: A home-based exercise program for children with HCM was developed, adapted from feedback, and the components were agreed to by experts in the field using a modified Delphi method. The next step in this process is to assess the safety and feasibility of this program in an in-hospital setting, prior to its evaluation through a multi-center, home-based exercise intervention.

For smaller pediatric patients on ventricular assist devices (VADs), the Berlin Heart EXCOR® remains the main form of durable support. It requires a connection to the external IKUS which has limited portability and battery life. The new EXCOR® Active mobile driving unit has battery life up to 13 hours. We describe the first North American experience with the EXCOR® Active in pediatric patients with a Berlin Heart device. Retrospective chart review was undertaken. Between Oct/2022 to Mar/2024, seven patients were on a Berlin Heart and supported with the EXCOR® Active. All patients were initially supported with the IKUS with a median time to transition to the EXCOR® Active of 12.0 days (IQR 9.5, 18.5) and a median time of support with the EXCOR® Active of 65.0 days (IQR, 32.0, 81.0). The EXCOR® Active posed no significant safety issues and minimal operating issues were noted. Following transition from IKUS to the EXCOR® Active there was increased patient and caregiver mobility throughout the hospital. Use of the EXCOR® Active has the potential to improve quality of life in pediatric patients waiting for heart transplantation.