Durable mechanical circulatory support as bridge to heart transplantation

Abstract

Purpose of reviewDurable mechanical circulatory support (MCS) technology has changed over time as devices have evolved from pulsatile to continuous flow support. In this review, we discuss recent data and substantial changes to current practice as it pertains to the subject of current era durable left ventricular assist devices (LVADs) as a bridge to heart transplantation.Recent findingsThe results of heart transplantation in patients bridged with durable LVAD support are satisfactory even after prolonged duration of support. Reports of recent experience with LVAD related infection suggest that this complication has limited impact on post-transplant outcomes. Important sex-related disparities continue to exist following durable LVAD implantation. Recent changes in the United Network for Organ Sharing donor heart allocation policy have resulted in a drastic decline in the use of durable LVAD support for Bridge to Transplant in the United States.SummaryDurable MCS in the form of LVAD as a BTT strategy continues to evolve over time. Optimization of its role in the treatment of end-stage heart failure, particularly in females will need to be the focus of future research.

Impact of Previous Conventional Cardiac Surgery on the Clinical Outcomes After Heart Transplantation

“…Before transplantation, high-risk conventional cardiac surgery cannot be completely avoided, as it still serves as an alternative strategy in cases where the organ is unavailable [7]. However, with advancements in ventricular assist devices (VADs), up to 45% of HTs are performed in recipients who have received mechanical circulatory support before transplantation, and the outcomes have been satisfactory [8][9][10]. Although VAD implantation also requires an open chest and increases the complexity of subsequent HT, its benefits can mitigate the negative impact of re-sternotomy [11][12][13][14].…”