Ventricular Assist Devices

Abstract

Heart failure is a common and debilitating disease with about 40 million affected worldwide. While there has been some improvement in the optimal medical therapy over the last two decades there is a worldwide stagnation in the number of heart transplantations which is only available to a very few selected patients. The emergence and progress in mechanical circulatory support strategies over the same period has provided a real hope for those patients who have otherwise similar life expectancy to terminal cancer patients. Devices like the IABP have been around for longer but it was the advent of extracorporeal pulsatile and especially the so-called second and third generation ventricular assist devices that provided a real progress in the surgical treatment of heart failure. Devices like the HeartMate II and the HeartWare MVAD found widespread application as intracorporeal continues-flow left ventricular assist devices. Initially the licences were for bridge to transplantation but more and more patients are now receiving these devices as destination therapy. There are certain specific complications like device thrombosis, bleeding and driveline infection that are related to these devices and are the focus of current research and development so that over the next decade or so that we can anticipate that newer devices may provide a direct alternative to transplantation with the advantage of its availability off the shelf. The ensuing increased usage of these devices will possibly reduce the cost to more affordable rates for the health care providing institutions worldwide which will make them available to millions of patients who have otherwise a very bleak outcome.