Patient Selection Criteria for Left Ventricular Assist Device Placement

Abstract

The incidence of end-stage congestive heart failure is currently estimated at 50,000 cases per year in the United States.^1,2 The majority of these patients are potential heart transplant recipients. The availability of donor organs, however, remains relatively fixed at approximately 2,000 annually.³ This vast discrepancy has led to the successful development of left ventricular assist devices (LVADs) as a bridge-to-transplantation and has raised the issue of permanent device implantation in lieu of transplantation.⁴ Although alternative technologies such as skeletal muscle cardiomyoplasty, crossspecies transplantation, and transgenic animal breeding have been proposed, LVADs are the only clinically viable alternative in the near future. In addition to avoiding the immunosuppression complications of transplantation and the long-term limitations posed by accelerated atherosclerosis, LVADs could be produced in the large numbers required by the heart failure population. The limitations of LVADs include their cost, estimated at $50,000 per unit, and their risk of infection, thromboembolism, and mechanical failure.