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Pediatric cardiology is a field that largely relies on translation of innovation in its adult counterpart in order to improve patient outcomes and introduce new technology to the field. Few FDA-approved pediatric cardiac devices are available for clinical use, thus leading to widespread off-label use within the field. Nonetheless, adaption of devices and technology from the adult field has proven to improve patient outcomes and overall wellness. However, the diversity of congenital heart disease, in terms of basic anatomy and treatment response, continues to complicate results. The combination of diversity of anatomy and small population size make it difficult for identifying control populations on which to test new devices, thus limiting the amount of safety and efficacy data that can be gathered. With little guidance and long-term data due to off-label use and poor reporting infrastructure, physicians are often left to devise solutions on a case-by-case basis. While surgery continues to be a mainstay of pediatric cardiology, transcatheter approaches to treating congenital heart disease have continued to gain momentum. With increasing data and multiplying device options, physicians have various options for approaching congenital heart disease. More recently, the creation of large databases such as Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) has made evaluating the safety and efficacy of pediatric cardiac devices more realistic. In this review, various approaches to surgical and device treatment of congenital heart diseases and conditions will be explored in order to shed light on the current status of pediatric cardiac devices.