Mechanical Circulatory Support and the Role of LVADs in Heart Failure Therapy

Abstract

Heart failure is epidemic in the United States with a prevalence of over 5 million. The diagnosis carries a mortality risk of 50% at 5 years rivaling many diagnoses of cancer. Heart transplantation, long the “gold standard” treatment for end stage heart failure unresponsive to maximal medical therapy falls way short of meeting the need with only about 2,000 transplants performed annually in the United States due to donor limitation. Left ventricular devices have emerged as a viable option for patients as both a “bridge to transplantation” and as a final “destination therapy”.

Clinical Approach to Manage Gastrointestinal Bleeding with a Left Ventricular Assist Device (LVAD)

“…A heart transplant is the gold standard treatment for end-stage heart failure; however, due to the limited availability of donor hearts, it is difficult to perform a transplant on every patient with end-stage heart failure. According to statistics, only 2,000 transplants are performed every year as a consequence of the donor shortage throughout the United States [4]. Once readmissions for heart failure exacerbations seem to recur, the prognosis tends to get worse [5][6].…”

İleri evre kalp yetersizliği rehberi

“…Pompa akımında düşüş sağ kalp yetersizliği, aritmi, volüm açığı veya pompa trombozu gibi bir kısmı ciddi problemlere işaret edebilir. [335] Pompa yönetimi kalp yetersizliği tedavisinde önemli bir yer tutar. Pompanın debisi sağ kalp yetersizliğine veya sol ventrikülün tamamen boşala-rak "suction" yapmasına neden olmayacak şekilde en azından birkaç atımda bir aort kapağının açıldığı, konjestif semptomların olmadığı ayarda tutulmalı-dır.…”

Past and Present of Total Artificial Heart Therapy: A Success Story

“…However, the paucity of available donors, much less the dysfunction of almost 60% of donated hearts, is a major hurdle impeding attempts to save the lives of these patients by means of transplantation [ 7 , 8 ]. Furthermore, waiting for a heart is a survival battle that almost 45% of patients lose [ 9 ]. Mechanically supporting the failing heart with ventricular pumps has emerged as an endeavor to preserve patients’ lives as long as possible until a donor heart is available, a term referred to as “bridge to transplantation” (BTT) [ 10 ].…”

“…Ventricular assist devices (VAD) were sought and utilized as early as the mid-1960s, until they were FDA-approved in the mid-1990s [ 9 ]. Indeed, VAD did prolong life, and early studies have shown a doubling in the 1-year survival rate (from 25% to 51%) in end-stage HF patients [ 11 ].…”