Left ventricular assist devices in heart failure

Abstract

End-stage heart failure is an ever-growing and devastating disease. The median survival for patients with heart failure on ionotropic support alone is a meager 6 months. Historically, the only option for these patients was to be listed for heart transplantation. Out of medical necessity, the idea of left ventricular assist device (LVAD) as a bridge to transplantation was born. Since their approval by the US FDA, LVADs have quadrupled the survival in patients with heart failure. The increase in survival has also been accompanied by decreased perioperative morbidity, better biocompatibility and longer device life over first-generation LVADs. Undoubtedly, LVADs have changed the landscape of heart failure treatment and will continue to do so in the foreseeable future. In this review, we will highlight the landmark studies that have established LVADs as a therapeutic option for heart failure, as well as reviewing the current LVADs available and speculating on the advancements that will be made in the upcoming years.

Severity of End-Organ Damage as a Predictor of Outcomes After Implantation of Left Ventricular Assist Device

“…2 There has also been continued improvement in postoperative results with reported 1 and 2 year survival of 79% and 66%, respectively. 3 The application of LVADs for DT has doubled since 2006 to 34% of all implants. 1 The American College of Cardiology and American Heart Association recommend using LVAD as DT for advanced heart failure patients that do not respond to standard therapy, are not transplantation candidates, and have <50% predicted 1 year survival.…”

“…5 Infection and bleeding still occur in >40% of patients after implantation. 3 These adverse events contribute to increased hospital readmissions and costs, decreased patient satisfaction, as well as potential for increased mortality. Although improvements in device durability and reliability have contributed to recent success, it is vital to consider patient selection to further improve outcomes.…”

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“…However, the lack of suitable donors for many of these patients clearly highlights the value of LVADs in the armamentarium of advanced heart failure surgical options. 8,9 …”

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“…2 Furthermore, upwards of 30% of patients undergoing a heart transplant have had a prior left ventricular assist device, and this percentage is likely to become increased. 3 As a result, the incidence of posttransplant DHs is likely to become a significant concern.…”