Comprehensive Insights into Mechanical Circulatory Support in End-Stage Heart Failure

Dear Colleagues,

End-stage heart failure represents a growing disease affecting more than 64 million people worldwide. The gold standard of treatment is orthotopic heart transplantation, but the chronic shortage of donors and the strict waiting-list criteria for potential recipients mean that this option is not suitable for all patients. As a result, the field of mechanical circulatory support is growing exponentially, successfully helping patients to prolong their life expectancy while waiting for the optimal donor (so-called bridge-to-transplantation therapy) or from the perspective of lifelong assistance (destination therapy). Nevertheless, the currently available devices are far from optimal and still present a number of inconveniences, ranging from hemocompatibility to altered physiology under support, the risk of infection, the need to recharge batteries, and technical problems.

Another issue that needs to be addressed is that heart failure may be predominantly secondary to mono-ventricular left-ventricular dysfunction, or, conversely, it may involve both ventricles. This can occur because the underlying disease affects the myocardium and therefore the entire heart (as in certain cardiomyopathies) or because a long-standing left-ventricular pathology evolves into a total cardiac entity. Since the detection of the gray zone between a single left or bilateral cardiopathy influences the decision to implant a mono-ventricular device (left-ventricular assist device, LVAD) or a biventricular assistance (total artificial heart or paracorporeal machines), which are known to be more complex and burdened by higher morbidity and mortality, clinicians are still searching for the most accurate diagnostic tools and algorithms to assess right-ventricular function.

In conclusion, we can affirm that mechanical assistance devices represent an attractive and useful option that is undergoing continuous evolution, with several improvements needed in order to allow a wide and safe range of applications with acceptable quality of life for patients.

The aim of this Special Issue is to showcase the latest advances and research in mechanical circulatory support. We invite researchers, engineers, and healthcare professionals working in this field to submit and share their innovative solutions and findings. Topics of interest include, but are not limited to, the physiopathology of cardiac assistance, biomedical imaging for the pre-implantation evaluation of the right ventricle, hemocompatibility in devices, the design and development of current and future assistance devices, cardiac tissue engineering, alternative energy sources, and new directions in cardiac technologies.

Dr. Claudia Maria Loardi
Dr. Emmanuelle Vermes
Dr. Marco Zanobini
Guest Editors

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