Current State of Ventricular Assist Devices

Abstract

Left ventricular assist device (LVAD) support is an accepted treatment of patients with end-stage heart failure. The increased applicability and excellent results with LVADs have revolutionized the treatment options available for such patients. Success with LVADs as bridge-to-transplant therapy has led to their successful use as an alternate to a transplant (ie, as destination therapy [DT]). The use of these devices as DT represents a relatively newer but growing indication. Until recently, most patients who have undergone LVAD implantation have been supported by pulsatile devices. Newer continuous-flow (CF) pumps have resulted in superior outcomes, including significantly reduced complication rates with improved durability over first-generation pulsatile design pumps. However, as with all new technology, the newer LVADs have introduced management challenges that were either unimportant or absent with pulsatile LVADs. This article reviews the current state of left ventricular devices, focusing on the CF pumps that currently dominate the field, including clinical outcomes, the physiologic and pathologic effects that are associated with CF pumps, and their unique management issues and complications.

Devices in Heart Failure

“…The axial flow pumps were second-generation continuous devices that used cylindrical motors and a helical rotor, which moved blood in alignment with the rotor axis; the centrifugal pumps moved blood circumferentially from the center outward. 57 Issues with centrifugal pumps include bleeding, infections, and perioperative right heart failure; 58-60 the bleeding may be related to high shear stress and defect in von Willebrand factor. 61, 62 The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) collects data on MCS from 2006 in the United States.…”

Endogenous Cardiac Stem Cell Therapy for Ischemic Heart Failure

“…Mechanical circulatory support (MCS) with the left ventricular assist device (LVAD) has been used as bridge-to-transplant (BTT) or bridge-to-recovery (BTR) therapies over the past decade [31]. In addition, because of its efficacy in BTT and BTR and with the development of newer LVADs with continuous-flow pumps, the longterm use for end-stage HF patients who are ineligible for transplantation (i.e., destination therapy; DT) is becoming more prevalent [36][37][38]. LVAD resulted in 1-year survival of nearly 80% and improvements in symptoms and quality of life in patients with advanced or end-stage HF [39].…”

Patients With Continuous-Flow Left Ventricular Assist Devices Provide Insight in Human Baroreflex Physiology

“…2,4,7 The good clinical outcome challenges the physiological dogma that cardiovascular homeostasis, particularly baroreflex regulation, requires pulsatile blood flow and pressure. Pulsatile pressure minimizes central baroreflex resetting and attenuates efferent sympathetic activity.…”

“…1 Of those, 250 000 die each year despite improvements in pharmacotherapy and increasing implantable defibrillator use. 2 Access to cardiac transplantation, which improves symptoms and survival, is limited by donor organ shortage. 2,3 Initially, left ventricular assist devices (LVADs) served as a short-term bridge to transplantation.…”

“…2 Access to cardiac transplantation, which improves symptoms and survival, is limited by donor organ shortage. 2,3 Initially, left ventricular assist devices (LVADs) served as a short-term bridge to transplantation. Technology refinement and device miniaturization allowed LVAD-treated patients to leave the hospital for months or even years.…”