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Implantable left ventricular assist device: indications, eligibility and current outcomes
  1. Sai Kiran Bhagra,
  2. Stephen Pettit,
  3. Jayan Parameshwar
  1. Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Sai Kiran Bhagra, Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire CB2 0AY, UK; sai.bhagra{at}gmail.com

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Learning objectives

  • To review the current indications for implantable left ventricular assist device (LVAD).

  • To understand the specific preimplant considerations for LVAD candidacy.

  • To review contemporary survival and morbidity outcomes on LVAD support.

Introduction

In patients with heart failure (HF) and left ventricular ejection fraction ≤40%, the annualised rate of progression from stage C to stage D HF is approximately 4.5%.1 In the non-inotrope-dependent patient with advanced HF (AdHF), survival without left ventricular assist device (LVAD) or urgent heart transplant (HTx) is poor, with only 53% alive at 2 years.2 While cardiac transplantation is the treatment of choice for highly selected patients with AdHF, with a median post-transplant survival of 12.5 years,3 the need for donor organs continues to far exceed availability.

In the 1960s the first mechanical pump to replace the failing heart was developed. By the early 1980s, HTx was established as a successful treatment, and it became clear that a method of keeping patients supported until a donor organ could be found was important. In 1984 the first successful electric pulsatile Novacor LVAD was implanted as a bridge to transplantation. The pulsatile HeartMate XVE was granted Food and Drug Administration (FDA) approval for ‘destination therapy’ in 2003. Pulsatile devices were bulky, required a large pocket in the abdomen and had limited durability. The advent of smaller, implantable, continuous-flow devices led to this type of therapy becoming a realistic long-term option for patients with AdHF. Over 2500 LVADs are now implanted annually worldwide.4

This article will cover the indications for LVAD implantation, preoperative considerations and clinical outcomes for continuous-flow LVADs (cfLVADs) used in contemporary practice. Due to the significant reduction in the use of axial flow devices,5 the article will focus on the current third-generation centrifugal devices.

Our review will not detail the management of patients …

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Footnotes

  • Contributors All authors were involved in planning, writing and review of this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references.

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