Concerning thromboembolism associated with left ventricular assist devices.

Abstract

Time for primary review 17 days. Cardiac surgeons are obligated to find solutions for patients with end-stage cardiac failure. Cardiac transplantation has provided the most successful option thus far but demand far exceeds the supply of donor hearts and demand is projected to increase while supply will level off, or perhaps decline [1]. Because of this shortfall in donor hearts there has been continued effort and emphasis on development of alternatives to cardiac transplantation [2]. Recently it was estimated that by the year 2010 between 35 000 and 70 000 patients in the USA alone would be candidates for permanent cardiac replacement or support [3]. Early versions of blood pumping devices, most containing silicone rubber blood sacs, experienced major problems with thrombosis. [4] Dacron-flocked surfaces were promulgated as a solution, the theory being that the formation of a ‘pseudo-intimal’ lining on these devices would be non-thrombogenic [5]. Early efforts with textured surfaces resulted in impaired diaphragm flexibility, hemolysis, and embolization [6], but these problems seem to have been resolved in the more modern devices. A major breakthrough in materials was made with the introduction of segmental polyurethanes in 1967. That led to adoption of this ‘smooth’ material for almost all devices [7]. Problems related to blood sac calcification, soft tissue pannus at the atrial cuff, and major thrombosis problems were gradually resolved with the introduction of low profile valves, and a host of iterative improvements in geometry, design, control systems, power sources, and driving systems. We are now to the point where … * Tel.: +1-217-333-2506; fax +1-217-244-1560. Dr. Gross was formerly Professor and Director of the Cardiovascular Surgery Research Laboratories, Division of Cardiovascular and Thoracic Surgery, College of Medicine, University of Kentucky. He is currently Professor and Head, Department of Veterinary Biosciences, College of Veterinary Medicine, University of Illinois, Urbana-Champaign.