Choosing the appropriate left ventricular assist device for your patient
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Choosing the appropriate left ventricular assist device for your patient Trever Symalla 1
&
Valluvan Jeevanandam 1
Received: 26 September 2019 / Accepted: 10 October 2019 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract The increasing incidence of advanced heart failure and severe donor organ shortage for cardiac transplant has led to the development of implantable left ventricular assist devices (LVAD) for long-term mechanical circulatory support. There has been tremendous improvement in the device technology of LVADs, and there are a number of devices in use throughout the world. This article reviews the evidence behind each device and their unique features that can help when choosing a durable LVAD for an individual patient. Keywords Left ventricular assist device . Mechanical circulatory support . Advanced congestive heart failure . Patient selection
Introduction Advanced congestive heart failure (aCHF) is a debilitating disease with a profound effect on a patient’s functional status, quality of life (QOL), and their survival. Despite advancements in the medical management of CHF, for patients with aCHF, only surgical interventions have had a significant impact on functional status, QOL, and survival [1]. The most effective surgical treatment remains heart transplantation, with a median survival of 10.7 years and marked improvement in functional status and QOL [2]. However, heart transplantation is limited by the number of available donor organs. In the USA, between 1987 and 2012, 40,253 patients were listed for heart transplant, but only 26,943 transplants were performed [3]. Mechanical circulatory support (MCS) devices have been developed both as an adjunct and an alternative to heart transplantation. Implantable LVADs are the only MCS devices available for durable, long-term support and can be used either as a bridge to transplant (BTT) or as destination therapy (DT). This article will review the durable LVAD models that are available and discuss factors that contribute to choosing a specific model for an individual patient.
* Trever Symalla [email protected] 1
Department of Surgery Section of Cardiac Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL 60637, USA
Development of MCS devices originated with the artificial heart program at the US National Institute of Health in 1964. The first-generation LVADs were designed to provide pulsatile flow and were pneumatically driven. A significant drawback of these devices was their large size, which required a larger body habitus for implantation to be feasible. In addition, the pump was often implanted into the abdominal cavity, though it could be placed pre-peritoneal. The pneumatic drivers were very loud and decreased patients’ QOL. Subsequent devices were electrically driven. The first self-contained LVAD was approved by the US Food and Drug Administration (FDA) in 1998 as a bridge to transplant [4]. The REMATCH trial, a randomized controlled trial (RCT) of 129 patients, showed
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