Skip to main content

Advertisement

SpringerLink
Log in

Current Practice in Patient Selecting for Long-Term Mechanical Circulatory Support

  • Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

With the advances of mechanical circulatory support, the selection of patients has undergone many changes over the last decade. Determining who is suitable for left ventricular assist device (LVAD) implantation is important to understanding the overall risk and outcomes. As devices improve, it is expected that changes will continue in this field. This review describes current state of patient selection, evaluation, and optimization prior to implantation of a long-term circulatory support device.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, et al. Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2014;33:555–64. Most recent report on over 10,000 patients with LVADS including their risk factors, demographics and outcomes.

    Article  Google Scholar 

  2. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147–239.

    Article  PubMed  Google Scholar 

  3. Metra M, Ponikowski P, Dickstein K, McMurray JJV, Gavazzi A, Bergh C-H, et al. Advanced chronic heart failure: a position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2007;9:684–94.

    Article  PubMed  Google Scholar 

  4. Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2013;32:157–87. Most recent ISHLT guidelines for use of mechanical support.

    Article  Google Scholar 

  5. Holman WL. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS): what have we learned and what will we learn? Circulation. 2012;126:1401–6.

    Article  PubMed  Google Scholar 

  6. Stevenson LW, Pagani FD, Young JB, Jessup M, Miller L, Kormos RL, et al. INTERMACS profiles of advanced heart failure: the current picture. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2009;28:535–41.

    Article  Google Scholar 

  7. Shah KB, Thanavaro KL, Tang DG, Kasirajan V. Clinical outcomes for INTERMACS profile 1 patient implanted with the total artificial heart. J Heart Lung Transplant. 2013;32:S236.

    Article  Google Scholar 

  8. Alba AC, Rao V, Ivanov J, Ross HJ, Delgado DH. Usefulness of the INTERMACS scale to predict outcomes after mechanical assist device implantation. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2009;28:827–33.

    Article  Google Scholar 

  9. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson L, Miller M, et al. Long-term mechanical circulatory support (destination therapy): on track to compete with heart transplantation? J Thorac Cardiovasc Surg. 2012;144:584–603. discussion 597–598.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Baldwin JT, Mann DL. NHLBI’s program for VAD therapy for moderately advanced heart failure: the REVIVE-IT pilot trial. J Card Fail. 2010;16:855–8.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Slaughter MS, Meyer AL, Birks EJ. Destination therapy with left ventricular assist devices: patient selection and outcomes. Curr Opin Cardiol. 2011;26:232–6. Great review of how LVAD therapy and technology has improved in the use of the device for destination therapy.

    Article  PubMed  Google Scholar 

  12. Steffen RJ, Halbreiner MS, Zhang L, Fukamachi K, Soltesz EG, Starling RC, et al. Mechanical circulatory support for the right ventricle in the setting of a left ventricular assist device. Exp Rev Med Devices. 2014;11:587–93. Great summary of the importance of the RV in the setting of the need for LVAD implantation.

    Article  CAS  Google Scholar 

  13. Moazami N, Pasque MK, Moon MR, Herren RL, Bailey MS, Lawton JS, et al. Mechanical support for isolated right ventricular failure in patients after cardiotomy. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2004;23:1371–5.

    Article  Google Scholar 

  14. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr. 2010;23:685–713. quiz 786–788. Summary of guidelines outlining assessement of RV function as it is vitally important to LVAD consideration.

    Article  Google Scholar 

  15. Matthews JC, Koelling TM, Pagani FD, Aaronson KD. The right ventricular failure risk score. J Am Coll Cardiol. 2008;51:2163–72.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Atluri P, Goldstone AB, Fairman AS, MacArthur JW, Shudo Y, Cohen JE, et al. Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era. Ann Thorac Surg. 2013;96:857–63. discussion 863–864.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, et al. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010;139:1316–24.

    Article  PubMed  Google Scholar 

  18. Grant ADM, Smedira NG, Starling RC, Marwick TH. Independent and incremental role of quantitative right ventricular evaluation for the prediction of right ventricular failure after left ventricular assist device implantation. J Am Coll Cardiol. 2012;60:521–8.

    Article  PubMed  Google Scholar 

  19. John R, Mantz K, Eckman P, Rose A, May-Newman K. Aortic valve pathophysiology during left ventricular assist device support. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2010;29:1321–9.

    Article  Google Scholar 

  20. Adamson RM, Dembitsky WP, Baradarian S, Chammas J, May-Newman K, Chillcott S, et al. Aortic valve closure associated with HeartMate left ventricular device support: technical considerations and long-term results. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2011;30:576–82.

    Article  Google Scholar 

  21. Park SJ, Liao KK, Segurola R, Madhu KP, Miller LW. Management of aortic insufficiency in patients with left ventricular assist devices: a simple coaptation stitch method (Park’s stitch). J Thorac Cardiovasc Surg. 2004;127:264–6.

    Article  PubMed  Google Scholar 

  22. Wang TS, Hernandez AF, Felker GM, Milano CA, Rogers JG, Patel CB. Valvular heart disease in patients supported with left ventricular assist devices. Circ Heart Fail. 2014;7:215–22.

    Article  PubMed  Google Scholar 

  23. Aaronson KD, Patel H, Pagani FD. Patient selection for left ventricular assist device therapy. Ann Thorac Surg. 2003;75:S29–35.

    Article  PubMed  Google Scholar 

  24. Peura JL, Colvin-Adams M, Francis GS, Grady KL, Hoffman TM, Jessup M, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation. 2012;126:2648–67.

    Article  PubMed  Google Scholar 

  25. Piacentino V, Williams ML, Depp T, Garcia-Huerta K, Blue L, Lodge AJ, et al. Impact of tricuspid valve regurgitation in patients treated with implantable left ventricular assist devices. Ann Thorac Surg. 2011;91:1342–6. discussion 1346–1347.

    Article  PubMed  Google Scholar 

  26. Robertson JO, Grau-Sepulveda MV, Okada S, O’Brien SM, Matthew Brennan J, Shah AS, et al. Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2014;33:609–17.

    Article  Google Scholar 

  27. Fang JC, Stehlik J. Moving beyond “bridges”. JACC Heart Fail. 2013;1:379–81.

    Article  PubMed  Google Scholar 

  28. Moazami N, Feldman D. Rethinking the terminology of mechanical circulatory support. J Thorac Cardiovasc Surg. 2012;144:2–3.

    Article  PubMed  Google Scholar 

  29. Teuteberg JJ, Stewart GC, Jessup M, Kormos RL, Sun B, Frazier OH, et al. Implant strategies change over time and impact outcomes: insights from the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). JACC Heart Fail. 2013;1:369–78.

    Article  PubMed  Google Scholar 

  30. Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345:1435–43.

    Article  CAS  PubMed  Google Scholar 

  31. Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241–51.

    Article  CAS  PubMed  Google Scholar 

  32. Boyle AJ, Ascheim DD, Russo MJ, Kormos RL, John R, Naka Y, et al. Clinical outcomes for continuous-flow left ventricular assist device patients stratified by pre-operative INTERMACS classification. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2011;30:402–7.

    Article  Google Scholar 

  33. Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357:885–96.

    Article  CAS  PubMed  Google Scholar 

  34. Riebandt J, Haberl T, Mahr S, Laufer G, Rajek A, Steinlechner B, et al. Preoperative patient optimization using extracorporeal life support improves outcomes of INTERMACS Level I patients receiving a permanent ventricular assist device†. Eur J Cardiothorac Surg Off J Eur Assoc Cardiothorac Surg. 2014;46:486–92.

    Article  Google Scholar 

  35. Tsiouris A, Morgan JA, Nemeh HW, Hodari A, Shah R, Brewer RJ, et al. Does elective or emergent operative status influence outcomes in patients undergoing implantation of left ventricular assist devices? Heart Surg Forum. 2014;17:E64–72.

    Article  PubMed  Google Scholar 

  36. Trivedi JR, Cheng A, Singh R, Williams ML, Slaughter MS. Survival on the heart transplant waiting list: impact of continuous flow left ventricular assist device as bridge to transplant. Ann Thorac Surg. 2014;98:830–4.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

M. Scott Halbreiner, Edward Soltesz, Randall C. Starling, and Nader Moazami declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave, J4-133, Cleveland, OH, 44195, USA

    M. S. Halbreiner & E. Soltesz

  2. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    R. Starling

  3. Heart Failure and Cardiac Transplant Medicine, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    R. Starling

  4. Kaufman Center for Heart Failure, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    R. Starling & N. Moazami

  5. Department of Thoracic and Cardiovascular Surgery, The Heart and Vascular Institute and the Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, J4-133, Cleveland, OH, 44195, USA

    N. Moazami

Authors
  1. M. S. Halbreiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Soltesz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Starling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Moazami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Moazami.

Additional information

This article is part of the Topical Collection on Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Halbreiner, M.S., Soltesz, E., Starling, R. et al. Current Practice in Patient Selecting for Long-Term Mechanical Circulatory Support. Curr Heart Fail Rep 12, 120–129 (2015). https://doi.org/10.1007/s11897-014-0243-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-014-0243-3

Keywords

Search

Navigation