Mechanical Circulatory Support as a Bridge to Heart Transplantation

Abstract

Heart failure (HF) continues to be a pandemic due to the growing burden of an aging population and the rising incidence of the disease. The success of medical therapy and cardiac resynchronization therapy has yielded a population of advanced HF patients with poor quality of life, frequent hospitalizations and hemodynamic instability. Heart transplantation remains the gold standard treatment for such patients; however, the small number of available donor organs and contraindications to heart transplantation in very sick patients limits this therapeutic approach. For those facing prolonged waiting times, mechanical circulatory support of the failing heart has emerged as an effective bridging strategy which has revolutionized the treatment of late stage heart failure. Outcomes after left ventricular assist device (LVAD) placement have significantly improved with the newer devices. Operative mortality in well-selected patients has improved to 5–10 % and the 1-year overall survival has improved to nearly 80 % as compared to 90 % after heart transplantation. Following upon the success with bridging patients to transplantation and the emergence of durable continuous flow pumps, there is a growing enthusiasm to apply this technology as lifelong therapy. Undoubtedly, LVADs have changed the landscape for the treatment of HF and the technology will continue to develop in the foreseeable future. This chapter provides an up to date overview of current LVAD technology and highlights the novel landmark studies that have established LVADs as a therapeutic option for HF.