The role of mechanical circulatory support as destination therapy for ambulatory heart failure.

James K Kirklin

doi:10.21542/gcsp.2016.24

Abstract

Continuous flow technology has dramatically improved patient survival during ventricular assist device (VAD) therapy in recent years. Health-related quality of life is improved by at least two years. Despite remarkable progress in this field, major adverse events during VAD support limit the effectiveness of this therapy and present major barriers to its extension to ambulatory advanced heart failure patients. The pace of progress will depend on improvements in both the adverse event profile and development of semi-quantitative methodology to calculate and display a composite of survival and health-related quality of life.

Highlights

Since the earliest iterations of mechanical circulatory support (MCS) devices, engineers and visionary surgeons have contemplated truly long-term support of the failing circulation that could be applied before the terminal stages of heart failure
Even after the REMATCH trial demonstrated a significant survival advantage for desperately ill advanced heart failure patients compared to medical therapy,[1] the adverse event profile was too unfavorable to justify application in less sick patients
One of the most pressing groups of ambulatory advanced heart failure patients are those patients who have been accepted for cardiac transplantation, but whose status is not sufficiently urgent to justify the highest priority for donor allocation

Summary

Introduction

Since the earliest iterations of mechanical circulatory support (MCS) devices, engineers and visionary surgeons have contemplated truly long-term support of the failing circulation that could be applied before the terminal stages of heart failure. Even after the REMATCH trial demonstrated a significant survival advantage for desperately ill advanced heart failure patients compared to medical therapy,[1] the adverse event profile was too unfavorable to justify application in less sick patients.

Results

Conclusion