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Optimization of Right Ventricular Function Preoperatively for LVAD Implantation

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Mechanical Circulatory Support for Advanced Heart Failure

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Abstract

Heart failure (HF) continues to place a significant burden on the current healthcare system. In 2012, the total direct medical cost for HF was $20.9 billion, and this is expected to increase to $53.1 billion in 2030 (representing a 2.5-fold increase). The majority of these costs are related to hospitalization [1]. Left ventricular assist devices (LVAD) were developed to provide end-stage heart failure patients opportunities to wait for a heart on a bridge-to-heart transplant (BTT) strategy or improve survival for those who were not eligible for heart transplantation on a destination therapy (DT) pathway. Since the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial reported a 48% reduction in risk of death in patients with advanced heart failure with the HeartMate XVE LVAD versus medical management, there has been an exponential increase in the number of mechanical circulatory assist devices for NYHA class IIIB/IV, stage D heart failure [2]. The HeartMate II study reported a significant survival advantage of continuous-flow ventricular assist devices (CF-VAD) over the older pulsatile HeartMate XVE device in a BTT strategy and opened the door for continuous-flow VADs (CF-VAD) that have since become standard of care [3].

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Authors and Affiliations

  1. Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, TX, USA

    Salman Gohar M.D. & Samar Sheth M.D.

  2. Mechanical Assist Devices, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, TX, USA

    Reynolds Delgado III M.D.

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  1. Salman Gohar M.D.
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  2. Samar Sheth M.D.
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  3. Reynolds Delgado III M.D.
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Corresponding author

Correspondence to Reynolds Delgado III M.D. .

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Editors and Affiliations

  1. Division of Cardiothoracic Transplantation, Surgical Director, Mechanical Circulatory Support and Cardiac Transplantation, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, Texas, USA

    Jeffrey A. Morgan

  2. Medical Director, Heart Transplant Program, Co-Director, Advanced Heart Failure Center, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, Texas, USA

    Andrew B. Civitello

  3. Center for Cardiac Support, Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, Texas, USA

    O.H. Frazier

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Gohar, S., Sheth, S., Delgado, R. (2018). Optimization of Right Ventricular Function Preoperatively for LVAD Implantation. In: Morgan, J., Civitello, A., Frazier, O. (eds) Mechanical Circulatory Support for Advanced Heart Failure . Springer, Cham. https://doi.org/10.1007/978-3-319-65364-8_3

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