Clinically available extracorporeal assist devices.
Mechanical circulatory support has been shown to be of benefit to allow recovery after conventional heart surgery and as a successful bridge to heart transplantation. Recent clinical trials with implantable left ventricular assist devices (LVADs) have been completed with these devices showing restoration of normal hemodynamics and successful bridge to transplantation. A major advantage of the implantable devices is the ability for the patient to be discharged and followed up at an outpatient setting. However, multiple advantages to extracorporeal devices still remain, which are the focus of this review. One advantage of the extracorporeal devices is that they can be placed in much smaller patients than currently available implantable LVADs. Also, because of differences in design of the assist devices, the extracorporeal devices can be placed without the need for the cardiopulmonary bypass and with decreased operative time and dissection. Perhaps the biggest advantage of the extracorporeal devices is that they can provide a support for both the right and left side of the heart as opposed to the implantable LVADs, which are only used as left ventricular assist devices. This article describes in detail the advantages and disadvantages of the extracorporeal devices as well as the operative techniques used to implant them. As the number of patients with heart failure continues to rise, so will the need for mechanical circulatory support. Though the majority of these patients will be served by a long-term implantable device, there will remain a subset of patients that will be best suited for treatment with extracorporeal devices.
Department of Surgery, Jewish Hospital Heart and Lung Institute, University of Louisville, KY, USA. rddowl01@athena.louisville.edu
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D001243:Assisted Circulation / Q000295:instrumentation / Q000706:statistics & numerical data; D004867:Equipment Design; D004869:Equipment Safety; D006333:Heart Failure / Q000601:surgery; D006801:Humans