Chapter 3 - First-generation ventricular assist devices

Abstract

Left ventricular assist devices (LVADs) have been developed to support end-stage heart failure patients. First-generation LVADs are volume displacement pumps, which function by mimicking the native heart and can be implanted intra-, extra-, or paracorporeally. These devices operate by periodically allowing blood to fill a pumping chamber followed by an ejection of blood from that chamber via pneumatic or electric actuation. Initial development of volume displacement pumps for post-cardiotomy support was undertaken in the 1960s. In 1978, the first patient was bridged to heart transplantation using a LVAD. Subsequently, commercial LVADs became available in the late 1980s and early 1990s. In 2001, the “Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial” established the efficacy of first-generation LVADs, finding that LVADs improved patient survival and quality of life compared to optimal medical management. Although commercially approved volume displacement pumps have demonstrated improved outcomes in comparison to medical therapy and deliver pulsatile flow, their durability, reliability, and reduced survival rates, in contrast to rotary blood pumps, have limited their use. Future considerations of volume displacement pumps have included flow optimization, valve design, and designing a cost-effective device.