title: Ventricular assist devices for treatment of acute heart failure and chronic heart failure.
abstract: Despite therapeutic advances that improve longevity and quality of life, heart failure (HF) remains a relentless disease. At the end stage of HF, patients may become eligible for mechanical circulatory support (MCS) for the indications of stabilising acute cardiogenic shock or for chronic HF management. MCS use is growing rapidly in the USA and some countries of the European Union, especially in transplant-ineligible patients. In others, it remains largely a tool to stabilise patients until heart transplant. MCS comprises a heterogeneous group of temporary and durable devices which augment or replace the pumping function of one or both ventricles, with postimplant 2 year survival rivalling that of transplant in selected, lower-risk patients. In transplant-eligible and non-transplant-eligible patients, improvement in end-organ perfusion, functional capacity and quality of life have been noted. Even for optimal candidates, however, there are a host of potential complications that require constant vigilance of a coordinated care team. Recently, there has been official recognition of the importance of palliative care expertise in advance care planning preimplant and management of patients with ventricular assist devices at the end of their lives.
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: James N
authors.initials: JN
authors.lastname: Kirkpatrick
authors.affiliation: University of California at San Francisco Medical Center, San Francisco, California, USA.
authors.forename: Georg
authors.initials: G
authors.lastname: Wieselthaler
authors.affiliation: Spectrum Health, Grand Rapids, Michigan, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Strueber
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Martin G
authors.initials: MG
authors.lastname: St John Sutton
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Rame
mesh_terms: D000208:Acute Disease; D002908:Chronic Disease; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D018579:Patient Selection; D011474:Prosthesis Design; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right