Clinical Application of Left Ventricular Assist Devices

Dear Colleagues,

The REMACH trial changed the treatment philosophy of end-stage heart failure; durable left ventricular support is associated with superior survival over medical treatment. Over the last two decades, ventricular assist device technology has evolved. The continuous flow pumps replaced the volume displacement ones with better performance. The newest generation magnetically levitated centrifugal continuous flow pumps are more blood friendly, mitigating VAD-related complications, such as thrombosis and stroke. The midterm survival of patients with HeartMate3 LVAD is comparable to heart transplants; this has been taken into consideration for the heart allocation system in heart transplant candidates. Unless patients have right ventricular failure, driveline infection, or pump malfunction, it is not advised to subject them to heart transplant early after implantation; with this strategy, the patient has the maximum additive survival benefit of both treatment strategies. Although patients survival with LVAD support and normal right ventricular function is high, right ventricular failure remains the Achilles heel, with significantly worse clinical outcomes. One-year survival with biventricular support with two VADs or a Total Artificial Heart is 60% at best. VAD implantation in the right atrium may be related to improved pump patency and 1 year survival (authors series); however, the number of patients is not large enough to allow statistical significant difference.

Dr. Themistokles Chamogeorgakis
Guest Editor

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