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SEE PAGE 402 C ompared with its adult counterpart, the field of pediatric heart failure, until fairly recently, has been slow to adopt widespread use of ventricular assist devices (VADs). Both the lack of devices of a size appropriate for smaller children and the complexity of VAD technology providing full support in the setting of congenital heart disease (CHD) physiology have limited broader application of VADs. As such, despite Food and Drug Administration approval of the Berlin Heart Excor (Berlin Heart GmbH, Berlin, Germany) for children in 2005 and the development of the Pediatric Interagency Registry for Mechanical Circulatory Support in 2012, published reports on this topic have lacked the granularity to demonstrate outcomes on the basis of strategies of VAD support as a bridge to transplantation or recovery (2). In this issue of the Journal, Dipchand et al. (3) provide the largest international multicenter report of pediatric patients with VAD support as a bridge to transplantation across more than 2 decades of experience. Although heavily encumbered by the wide variety of devices implanted across several eras of study that witnessed transformative evolution in VAD technology, this paper