A Rising Hope of an Artificial Heart: Left Ventricular Assisted Device - Outcome, Convenience, and Quality of Life

Abstract

With the introduction of mechanical circulatory support, mainly continuous-flow left ventricular assisted devices (CF-LVAD), prolonging survival in end-stage heart failure patients can be seen in a new light. We also anticipate its use as a definitive therapy to overcome the limited donor organ resources for cardiac transplant. However, LVADs also have undesirable device-related complications and questionable improvement in the quality of life. In this review, we searched published articles using PubMed and Google Scholar to identify the complications and outcome of post-LVAD patients from 2014 to 2019. The studies we used included all study design types and a wide range of demographic variables focusing on age, sex, choice of LVAD as a bridge to cardiac transplant, or definitive therapy. For patients with New York Heart Association (NYHA) Class III B or IV or heart failure with reduced ejection fraction (HFrEF) with maximal medication therapy, there is a significant increase in mean ejection fraction from 4% to 6%. For patients with drug-induced cardiac toxicity or other causes of cardiac toxicity, with no significant risk factors, the ejection fraction increased to nearly 50% within 10-25 days of LVAD usage. There is also a substantial improvement in the quality of life in this literature review comparing to the pre-LVAD stage, as long as complications are taken into account. Data is limited for making an accurate judgment on the quality of life and functional capacity of LVADs. We found that the use of LVADs is not fully cost-effective, but still less financially burdening than a cardiac transplant. Although data from worldwide is limited and restricted to studies having a range of one to two years of follow-up, we conclude that LVADs are promising in improving cardiac function and the best bridging therapy available for patients waiting on a transplant.

Updates on Baroreflex Activation Therapy and Vagus Nerve Stimulation for Treatment of Heart Failure With Reduced Ejection Fraction

“…First, whether an improvement in LVEF by +3 to +6% after neuromodulatory therapy translates to clinically significant improvement in cardiovascular status is considered. Interestingly, improvements in LVEF by 4-6% have been reported following LVAD therapy [ 22 ]. These findings suggest that the ability of BAT and VNS to improve cardiovascular parameters may be in line with more standard advanced therapies, such as LVAD.…”

Ventricular Assist Devices and Their Usage as a Bridge to Recovery in Patients With Acute Cardiotoxicity and Cardiomyopathy

“…Because of the above complication risks, it is crucial for temporary LVAD treatment patients not only to be treated with anti-coagulants to prevent pump thrombosis but also to be monitored regularly to prevent fatal adverse outcomes (Table 1 ) [ 5 - 12 ].…”

Self‐care behaviours of patients with left ventricular assist devices in Israel: changes during the COVID‐19 pandemic

“…Heart failure (HF) is a serious clinical and public health problem affecting 64.3 million people worldwide 1 and about 180 000 people in Israel 2 . Management of end‐stage HF incorporates implantation of a left ventricular assist device (LVAD) as a bridge to heart transplantation or as the destination therapy 3 . Successful long‐term LVAD support requires a high degree of patient self‐care, including self‐care maintenance, self‐care monitoring, and self‐care management 4 .…”

“…2 Management of end-stage HF incorporates implantation of a left ventricular assist device (LVAD) as a bridge to heart transplantation or as the destination therapy. 3 Successful long-term LVAD support requires a high degree of patient self-care, including self-care maintenance, self-care monitoring, and self-care management. 4 During the COVID-19 pandemic, symptoms of anxiety and depression could have interfered with the self-care of patients with LVAD.…”