Heart Transplantation in the Era of the Left Ventricular Assist Devices

Abstract

Orthotopic heart transplant is recognized as the gold standard for the treatment of endstage heart disease. However, there is a perennial shortage of donor organs. Left ventricular assist devices (LVAD) represent a revolutionary tool for temporizing heart failure that is refractory to medical management until a suitable organ becomes available. This review highlights the LVAD as a tool for bridging to transplant. The history of the LVAD and its use in heart transplantation is described, as well as the current indications for use in the general heart transplant candidate as well as for selected subpopulations. It also highlights the major complications of LVAD use, advancements in the field, and selected current controversies related to the LVAD as bridge-to-transplant therapy.

Veno-arterial Extracorporeal Membrane Oxygenation as Bridge to Heart Transplantation: The Way Forward

“…The BTT strategy is of particular value in light of the results reported in patients listed for emergent HTx, who experience an increased load of complications as primary graft failure, need for postoperative dialysis, and in-hospital mortality. 9 …”

“…The BTT strategy is of particular value in light of the results reported in patients listed for emergent HTx, who experience an increased load of complications as primary graft failure, need for postoperative dialysis, and in-hospital mortality. 9 The heart allocation systems significantly diverge based on urgency criteria assignation and have to deal with chronic organ shortage and increasing demand. These factors may influence the BTT strategy.…”