Recent Advances in Cardiothoracic Assist Devices

Dear Colleagues,

Cardiothoracic Assist Devices (CADs) have undergone transformative advancements in recent years, revolutionizing the management of advanced heart failure. This Special Issue highlights cutting-edge innovations in cardiopulmonary and mechanical circulatory support (MCS), including ventricular assist devices (VADs), total artificial hearts (TAHs), an Organ Care system (OCS), Lung bioengineering (LBE), EVLP (Ex vivo lung perfusion), bonded circuits and minimally invasive systems, with a focus on improving durability, interface biocompatibility, and patient outcomes.

Key themes explored in this Special are as follows:

• Next-Generation VADs: The shift toward fully magnetically levitated (maglev) pumps (e.g., HeartMate 3) has significantly reduced complications like thrombosis and hemolysis, while enhancing long-term survival.
• Minimally Invasive and Pediatric Solutions: Devices such as Impella 5.5^® and miniaturized pediatric VADs are expanding treatment options for diverse patient populations.
• Wireless Power and Smart Systems: Advances in transcutaneous energy transfer (TET) and AI-driven adaptive control are minimizing infections and optimizing hemodynamic performance.
• Bioprosthetic and Total Artificial Hearts: Innovations like the Carmat TAH and SynCardia’s portable drivers are improving outcomes in biventricular failure.
• An OCS, LBE and EVLP for cardiac and pulmonary support and evaluation for transport of harvested hearts and lungs are discussed.
• Biocompatibility and Hemocompatibility: Novel coatings (e.g., heparin, endothelial cell-seeded surfaces) aim to reduce anticoagulation needs.

This collection of research underscores the rapid evolution of CADs toward smaller, smarter, and more physiological systems, offering new hope for heart failure patients through better organ preservation during transport, organ evaluation to increase transplant success rates, destination therapy, bridge-to-transplant, or recovery. Future directions, including bioengineered solutions and fully implantable systems, are also discussed, paving the way for the next era of cardiac support.

We invite readers to explore the breakthroughs that are reshaping the landscape of advanced heart failure therapy.

Dr. Suvitesh Luthra
Prof. Dr. Enrique Berjano
Guest Editors

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