Left Ventricular Assist Devices vs. Transplant | Ten Points to Remember
- Mancini D, Colombo PC.
- Left Ventricular Assist Devices: A Rapidly Evolving Alternative to Transplant. J Am Coll Cardiol 2015;65:2542-2555.
The following are 10 points to remember about left ventricular assist devices (LVADs) as a rapidly evolving alternative to transplant:
- With a persistent donor shortage and an increasing number of patients with Stage D heart failure, LVADs have been used as bridge to heart transplant for those who qualify for transplant (bridge to transplant) or as a substitute in those who do not (destination therapy).
- Despite ongoing measures to increase access to donor organs, organ availability remains a major limitation to heart transplant.
- The current strategy for the management of refractory Stage D heart failure with reduced ejection fraction (HFrEF) patients is to initially screen for heart transplant, with destination therapy VADs considered as secondary treatment for those who do not qualify.
- The current algorithm for screening patients for advanced HF therapies may need to be revisited, with a shift to considering patients initially for destination VAD and heart transplant reserved for selected patients or as bailout therapy.
- VAD support offers improved quality of life and survival compared to medical therapy, and in some cases, 2-year outcomes comparable to heart transplant. There are now more LVAD implants performed per year than heart transplants.
- LVAD complications persist and may have lessened enthusiasm for investigating LVAD therapy in less sick patients; however, technology continues to advance rapidly.
- Smaller devices, total implantability, pulsatility, and remote monitoring are being investigated and will broaden application of VAD technology.
- Clinical trials are needed to determine which patients benefit most from LVAD support versus heart transplantation.
- LVAD technology is evolving rapidly and its accessibility is increasing when compared to heart transplant.
- In the future, VADs may be considered initial therapy for Stage D HF, with heart transplant reserved for VAD failures and selected patients.
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