Invited Commentary

Abstract

The report from Germany by Dell'Aquila and colleagues [1Dell'Aquila A.M. Schneider S.R.B. Schlarb D. et al.Initial clinical experience with the Heartware left ventricular assist system: a single-center report.Ann Thorac Surg. 2013; 95: 170-178Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar], analyzing an initial experience with the Heartware left ventricular assist system, reflects the remarkable progress and proliferation of mechanical circulatory support over the past 5 years. The expansion of this complex technology has been closely chronicled since DeBakey's successful 10-day support of a 37-year-old woman with a paracorporeal pump in 1966 after failure to wean her from cardiopulmonary bypass after aortic and mitral valve replacements [2DeBakey M. Left ventricular bypass pump for cardiac assistance.Am J Cardiol. 1971; 27: 3Abstract Full Text PDF PubMed Scopus (299) Google Scholar]. After the Barney Clark total artificial heart experiment in 1982 [3DeVries W. Clinical use of the total artificial heart.N Engl J Med. 1984; 310: 273-278Crossref PubMed Scopus (230) Google Scholar], the National Institutes of Health stimulated collaborative research efforts to develop implantable left ventricular assist devices, culminating in the clinical introduction of multiple pulsatile systems over the next decade. The development of the rotary “continuous-flow” ventricular assist device lagged behind “first-generation” pulsatile devices. Wampler and colleagues introduced the catheter axial flow Hemopump in 1988 [4Wampler R. Moise J. Frazier O. et al.In vivo evaluation of a peripheral vascular access axial flow blood pump.ASAIO Trans. 1988; 34: 450-454PubMed Google Scholar], energizing the field of rotary pump technology. During the first decade of the twenty-first century, a plethora of rotary pumps entered trials in Europe and the United States, with some device companies not able to survive in a challenging clinical arena. The transition from pulsatile to continuous-flow technology in the United States was essentially complete by 2010, with over 95% of implants being continuous-flow pumps (HeartMate II) [5Kirklin J.K. Naftel D.C. Kormos R.L. et al.The Fourth INTERMACS annual report: 4,000 implants and counting.J Heart Lung Transplant. 2012; 31: 117-126Abstract Full Text Full Text PDF PubMed Scopus (324) Google Scholar]. The Heartware device, as evidenced by the superb clinical outcomes reported by Dell'Aquila and colleagues in this issue, extends the clinical platform of continuous-flow pumps to centrifugal flow technology. This device was selected by the REVIVE-IT investigators in a proposed trial of long-term therapy for patients with stable advanced heart failure [6Baldwin J.T. Mann D.L. NHLBI's program for VAD therapy for moderately advanced heart failure: the REVIVE-IT pilot trial.J Card Fail. 2010; 16: 855-858Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar]. Now that clinical trials in the United States have been completed, the US Food and Drug Administration will soon decide on approval for the bridge-to-transplant indication. If approved, this small durable pump will provide an important addition to the portfolio of technology to support patients with advanced heart failure. Initial Clinical Experience With the HeartWare Left Ventricular Assist System: A Single-Center ReportThe Annals of Thoracic SurgeryVol. 95Issue 1PreviewThe HeartWare ventricular assist device (HVAD) system (HeartWare International Inc, Framingham, MA) is a new centrifugal continuous-flow ventricular assist device. The aim of the present study is to review our institutional experience with this novel device. Full-Text PDF