Advances in mechanical circulatory support

Abstract

Mechanical circulatory support is expanding the treatment of advanced heart failure. The number of heart transplantations performed worldwide remains fairly static, and medical therapy alone for end stage heart failure continues to have dismal results. This article presents the authors' opinion as to the current status, challenges, and future course of the field of mechanical circulatory support. There is significant disparity between perceived and actuarial survival of a patient with the diagnosis of advanced heart failure. The traditional indications for mechanical circulatory support are becoming less relevant as the application of the therapy broadens. More devices with improved durability are becoming available, and patient selection, management, and outcomes continue to improve. Long-term myocardial recovery is possible in a population of patients with heart failure through the use of mechanical circulatory support combined with evolving pharmacologic therapy, gene therapy, and other forms of tissue regeneration (stem cells, cellular matrix). Mechanical circulatory support holds great promise in the treatment of advanced heart failure. It is critical to change the perception of both the clinician and the patient toward the prognosis of end stage heart failure. The prospect of achieving long-term myocardial recovery using mechanical support as a platform for other strategies is exciting and requires intensive future investigation.