Mechanical circulatory assistance: changing indications and options.
The previously high rates of morbidity and mortality associated with implantation of LVADs for long-term support have continued to decline through design improvements, better patient selection criteria, and greater clinical experience. Patients which chronic heart failure awaiting transplantation should be considered for LVAD placement early in their clinical course, before irreversible end-organ dysfunction occurs. Both the Novacor and the vented electric HeartMate LVADs are currently being evaluated under "discharge to home" protocols for patients awaiting heart transplantation; the results will have tremendous economic and quality-of-life implications. Currently available devices have achieved a level of reliability that will allow for protocols involving device implantation as an alternative to transplantation in the near future. Physicians will then have an effective therapy available for the increasing number of heart failure patients awaiting a limited number of donor hearts, as well as for those patients not considered to be candidates for transplantation by traditional criteria.
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Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
D004867:Equipment Design; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D011788:Quality of Life; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*