Mechanical Circulatory Support: Evolution and History

Abstract

Since the development of the first cardiopulmonary bypass machine in the early 1950s, mechanical circulatory support (MCS) devices have undergone many revisions to reduce their size, portability, enhance biocompatibility, implantability, and improve clinical outcomes. Relatively early in the process of designing MCS devices, the National Heart Lung and Blood Institute provided guidance to further the development of left ventricular assist systems including goals to minimize adverse events. Pioneers in the field tirelessly tried and failed many times in attempting to successfully develop a VAD that met all goals. Innovators such as Gibbon, Cooley, Bernhard, Kirklin, DeWall, Kantrowitz, Frazier, Portner, and Olsen paved the path for helping patients live with MCS devices. Finally, in 1984, the first patient was discharged from the hospital with an implantable VAD. Thus was the inception of the VAD Coordinator; an extension of the physician who could devote requisite time to teach the patient and caregiver in self-management. Clinical trials in that era required community education for emergency responders and other care partners along with extensive data collection as regulatory agencies had great interest in the outcomes of these studies. The VAD Coordinator became an integral member of the team with extensive and varied responsibilities. Innovation continues today with the same goals established in 1975 by the NHLBI. However, the standard is elevated as successes continue in both the design and management of patients with VADs.