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Patient Selection for Long-Term Mechanical Circulatory Support: Is It Ever too Early for the NYHA Class III Patient?

  • Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (A Hasan, Section Editor)
  • Published:
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Abstract

Heart failure is a common condition with significant morbidity and mortality. Pharmacologic and device therapies have resulted in substantial improvements in heart failure outcomes. Despite optimal therapy, 10 % of patients progress to advanced HF, characterized by progressive symptoms, poor quality of life, and poor prognosis. The “gold-standard” treatment of advanced heart failure remains cardiac transplantation. However, the number of patients with advanced heart failure far exceeds available donor organs. Left ventricular assist devices (LVADs) were initially developed to bridge patients with hemodynamic collapse to transplantation. Their use resulted in marked improvements in survival and quality of life in select patients giving rise to increased and expanded overall implantation. Despite these improvements, patient selection and timing for LVAD therapy is still evolving. In this article, we will review a brief history of LVADs, examine patient selection, and explore the currently debated expansion of LVADs to “less sick” patients.

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Author information

Authors and Affiliations

  1. Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Andrea M. Elliott

  2. Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Heart Failure & Transplantation, 473 W. 12th Avenue, Suite 200, Columbus, OH, 43210, USA

    Brent C. Lampert

Authors
  1. Andrea M. Elliott
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  2. Brent C. Lampert
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Correspondence to Brent C. Lampert.

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Conflict of Interest

Andrea M. Elliott declares that she has no conflict of interest.

Brent C. Lampert has received consulting fees from St. Jude Medical outside of the submitted work.

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.

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

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Elliott, A.M., Lampert, B.C. Patient Selection for Long-Term Mechanical Circulatory Support: Is It Ever too Early for the NYHA Class III Patient?. Curr Heart Fail Rep 13, 13–19 (2016). https://doi.org/10.1007/s11897-016-0279-7

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  • DOI: https://doi.org/10.1007/s11897-016-0279-7

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