Long-term continuous-flow left ventricular assist devices (LVAD) as bridge to heart transplantation.
Heart transplantation (HTx) is the treatment of choice for end-stage heart failure but the limited availability of heart's donors still represents a major issue. So long-term mechanical circulatory support (MCS) has been proposed as an alternative treatment option to assist patients scheduled on HTx waiting list bridging them for a variable time period to cardiac transplantation-the so-called bridge-to-transplantation (BTT) strategy. Nowadays approximately 90% of patients being considered for MCS receive a left ventricular assist device (LVAD). In fact, LVAD experienced several improvements in the last decade and the predominance of continuous-flow over pulsatile-flow technology has been evident since 2008. The aim of the present report is to give an overview of continuous-flow LVAD utilization in the specific setting of the BTT strategy taking into consideration the most representative articles of the scientific literature and focusing the attention on the evolution, clinical outcomes, relevant implications on the HTx strategy and future perspectives of the continuous-flow LVAD technology.
1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
Matteo
M
Pozzi
1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
Raphaël
R
Giraud
1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
Piergiorgio
P
Tozzi
1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
Karim
K
Bendjelid
1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
Jacques
J
Robin
1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
Philippe
P
Meyer
1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
Jean François
JF
Obadia
1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
Carlo
C
Banfi
Heart failure; heart transplantation (HTx); organ donors; ventricular assist device