Past, Present, and Future of Long‐Term Mechanical Cardiac Support in Adults

Abstract

The growing number of heart failure patients and the scarcity of donor organs give rise to the development of mechanical circulatory support devices for a long-term support. After approximately 15 years of experience, these devices should be critically evaluated. The presented article gives an overview on the currently most often used mechanical circulatory support systems, describes the indications for implantation (bridge to cardiac transplantation, destination therapy, and bridge to recovery), the complications like bleeding, thromboembolic events, infections, and technical failures, and analyzes the costs of this therapy. Furthermore, alternative treatment options like cardiac transplantation, coronary artery bypass grafting, cardiac valve surgery, defibrillator implantation, multisite pacing, dynamic and passive cardiomyoplasty, partial left ventriculectomy (PLV), Myosplint implantation (Myocor, Maple Grove, MN, USA), stem cell therapy, and xenotransplantation are shortly presented, and the future of mechanical support devices is discussed. Despite a great number of patients benefitting from mechanical support devices, the treatment with these devices will only compete with other therapeutic strategies if the rates of complications and technical failures as well as the costs are significantly reduced. Furthermore, innovative therapies like biochemical influencing of the cardiac metabolism have a high potential and may play an important role in the future.

Renal Failure in Patients with Left Ventricular Assist Devices

“…The first generation of VADs was largely pulsatile devices (e.g., Thoratec Paracorporeal, Thoratec Implantable, HeartMate Vented Electric) with chambers that filled with blood, emptying through oneway valves via pneumatic mechanisms. These VADs were associated with high failure rates, infection, and bleeding (7). The most recent generation consists of continuous-flow devices, including both axial-flow and centrifugal-flow designs (e.g., HeartMate II, Jarvik 2000, HeartWare).…”

Patient-Reported Outcomes in Left Ventricular Assist Device Therapy

“…The most commonly used long-term devices are left ventricular assist devices (LVADs). 2,3 Left ventricular assist devices can be divided into 2 main types: (1) the pulsatile pumps that mimic the natural pulsing action of the heart and (2) the continuous flow pumps that can be subdivided into either centrifugal or axial flow pumps. 4 …”

Radiology of cardiac devices and their complications

“…The Myosplint system is no longer in use because of a lack of therapeutic effect and increased mitral valve insufficiency. 91 Emerging data from studies of the CorCap device show that the device is safe with long-term sustained benefits on ventricular remodelling, reduction in death and major cardiac procedure and improvement in heart failure. 92 The HeartNet, which is an elastic ventricular restraint device, is implanted circumferentially around the heart and applies a low level of epicardial pressure (Figure 18).…”