History of Durable Mechanical Circulatory Assist Devices

  • Ambar Afshar AndradeEmail author
  • Roxanne Siemeck
  • Tisha Suboc


Cardiac transplant has been a widely accepted therapy for end-stage heart failure; unfortunately, the supply of donor hearts does not meet the ongoing demand. Patients with end-stage heart failure can now safely undergo durable left ventricular assist device (LVAD) implantation. Furthermore, LVAD therapy has now expanded beyond patients who are not transplant candidates. About 50% of patients who undergo VAD implantation in the current era are implanted as destination therapy (DT). The modern era of cardiac surgery began with the use of the cardiopulmonary bypass (CPB) machine. The advent of CPB and open heart surgery thus allowed for the development of mechanical support of the failing heart. The inability to wean some patients from CPB sparked an interest in prolonged mechanical assistance to promote myocardial recovery. From the first implantable ventricular assist device, to the first human heart transplant, the field of mechanical circulatory support has been rapidly evolving. First generation ventricular assist devices were pulsatile in nature with a variety of designs and placement and were approved for use as a bridge to transplant and/or post-cardiotomy shock. The second generation LVADs include axial flow devices and the third generation devices are centrifugal flow devices. To date, the most utilized second generation pump is the HM II, with over 17,000 implants worldwide. The two main centrifugal flow pumps that are available today are the HeartWare HVAD and the HeartMate 3. Improvements in outcomes with mechanical circulatory support (MCS) for patients requiring LVADs have been universally recognized during the past decade. The 1- and 2-year survival with continuous flow pumps is currently 80% and 70%, respectively. Unfortunately, neurologic events, right heart failure, and multisystem organ failure are the predominant causes of death early after LVAD implantation. Infection, multiorgan system failure and neurologic events are the major causes of late mortality. The choice of which pump to implant comes down to implant indication, and unique patient conditions. Further device evolution will continue to shift the paradigm of LVAD therapy, possibly to implanting LVADs in less sick individuals in need of lower cardiovascular support. The basics of LVAD therapy will remain the same, and warrant continual knowledge seeking by clinicians involved in the care of patients with Stage D heart failure.


Mechanical circulatory support Heart failure Cardiogenic shock Post cardiotomy shock LVAD HeartMate II Heartmate 3 HeartWare HVAD Total artificial heart Heart transplant Myocardial recovery Right ventricular failure History of mechanical circulatory support 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ambar Afshar Andrade
    • 1
    Email author
  • Roxanne Siemeck
    • 2
  • Tisha Suboc
    • 3
  1. 1.Department of CardiologyAdvocate Christ Medical CenterOakLawnUSA
  2. 2.Department of Heart Transplant and Ventricular Assist DevicesAdvocate Christ Medical CenterOakLawnUSA
  3. 3.Department of CardiologyRush UniversityChicagoUSA

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