Ventricular assist devices as destination therapy.
The prospects for long-term mechanical circulatory support are improving. Axial flow pumps are a promising competitor to pulsatile first-generation LVADs, although the two may serve different patient populations. Centrifugal pumps are in the development phase and seem to require less anticoagulation. Clinical experience has established the safety of diminished pulse pressure circulation, and mechanical unloading appears to promote recovery of the native left ventricle. Under these circumstances, true left ventricular assist is preferable to ventricular replacement and detailed medical management improves patient outcomes. Further clinical trials of destination therapy are indicated and must use more reliable blood pumps implanted before terminal decline into multiorgan failure.
Westaby
Stephen
S
Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK. swestaby@ahf.org.uk
D002303:Cardiac Output, Low; D004867:Equipment Design; D004868:Equipment Failure; D004869:Equipment Safety; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*