title: Ethical Considerations in the Long-Term Ventricular Assist Device Patient.
abstract: As the heart failure population continues to age, the need for definitive therapies such as ventricular assist devices (VADs) to extend life and alleviate suffering from end-stage disease directly increases. The goal of this article is to examine the ethical principles of autonomy, beneficence, non-maleficence, and justice within the context of long-term VAD patients.
  
  
  
  Survival rates in VAD-implanted patients have improved in parallel with modernization of device design and surgical technique, reaching that of cardiac transplantation at 1 year post-procedure. Even the sickest patients, those once deemed transplant-ineligible, have been proven to benefit from device implantation and in some cases to a point of becoming eligible for cardiac transplantation. Nevertheless, VAD implantation remains a high-risk procedure with in-hospital mortality rates reaching up to 27% post-procedure and requires intensive upkeep even after successful implantation. Furthermore, end-of-life decisions are complicated by consideration of device deactivation in patients who may not die immediately from an otherwise lethal pathophysiology. Ethical considerations in selection of patients, goals of implantation, and length of therapy become important to preserve the efficacy of treatment and maximize resource utilization. Advanced directives, shared decision-making, and multi-disciplinary approach to treatment have been shown to improve outcomes with respect to both survival and quality of life.
authors.affiliation: Department of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.|Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Cai
authors.affiliation: Drexel University College of Medicine, Philadelphia, PA, USA. heisen@drexelmed.edu.|Division of Cardiology, Hahnemann University Hospital, Philadelphia, PA, USA. heisen@drexelmed.edu.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Eisen
mesh_terms: D000375:Aging; D004867:Equipment Design / Q000941:ethics; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000941:ethics*; D006801:Humans; D018579:Patient Selection / Q000941:ethics; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Advanced heart failure; Ethical considerations; Ventricular assist device