Ventricular Assist Devices: Current State and Challenges

2017 ◽  
Vol 11 (4) ◽  
Author(s):  
Siamak N. Doost ◽  
Liang Zhong ◽  
Yosry S. Morsi

Cardiovascular disease (CVD), as the most prevalent human disease, incorporates a broad spectrum of cardiovascular system malfunctions/disorders. While cardiac transplantation is widely acknowledged as the optional treatment for patients suffering from end-stage heart failure (HF), due to its related drawbacks, such as the unavailability of heart donors, alternative treatments, i.e., implanting a ventricular assist device (VAD), it has been extensively utilized in recent years to recover heart function. However, this solution is thought problematic as it fails to satisfactorily provide lifelong support for patients at the end-stage of HF, nor does is solve the problem of their extensive postsurgery complications. In recent years, the huge technological advancements have enabled the manufacturing of a wide variety of reliable VAD devices, which provides a promising avenue for utilizing VAD implantation as the destination therapy (DT) in the future. Along with typical VAD systems, other innovative mechanical devices for cardiac support, as well as cell therapy and bioartificial cardiac tissue, have resulted in researchers proposing a new HF therapy. This paper aims to concisely review the current state of VAD technology, summarize recent advancements, discuss related complications, and argue for the development of the envisioned alternatives of HF therapy.

Author(s):  
David A. Ramirez ◽  
Mikayle A. Holm ◽  
Andrew Shaffer ◽  
Paul A. Iaizzo

Abstract Implanting Left ventricular assist devices (LVADs) can be life saving therapies that improve life expectancy for the patients that receive it. The target patient population suffer from end-stage heart failure and are therefore susceptible to morbidities arising from a less than ideal surgical implantation. Importantly, the graft that carries the blood from the LVAD pump to the aorta needs to be sized accordingly so as to not cause any compounding complications. The current typical surgical method, is to perform a visual estimation at the time of implantation. This present study proposes a computational tool that utilizes pre-procedural imaging to better calculate the personalized, ideal, LVAD graft length.


2021 ◽  
pp. 039139882110538
Author(s):  
Alina Zubarevich ◽  
Konstantin Zhigalov ◽  
Marcin Szczechowicz ◽  
Arian Arjomandi Rad ◽  
Robert Vardanyan ◽  
...  

Background: The ideal timing of a durable assist device implantation in patients with end-stage heart failure presenting with INTERMACS profile I is still controversial. The data on extracorporeal life support (ECLS) bridge to durable left ventricular assist device (LVAD) in these patients is limited. Materials and methods: We retrospectively analyzed the outcomes of 35 patients in acute cardiogenic shock (CS) who, between December 2013 and September 2020, were bridged with ECLS to durable LVAD. The mean age was 52.3 ± 12.0 years. The primary endpoints of this study were in-hospital, 30-day, 6-month, and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events and other characteristics during the follow-up period. We also assessed the impact of the rescue ECLS on the recovery of the end-organ function. Results: In-hospital, 30-day, 6-month, and 1-year survival was 65.6%, 75.9%, 69.2%, and 62.7% respectively. The median time on ECLS was 7 days (IQR 5.0–13.0). We observed a high incidence of a severe right heart failure (22.9%), acute kidney injury on dialysis (68.6%), and respiratory failure (77.1%). Bridge with ECLS provided a significant recovery of liver and kidney function prior to durable LVAD implantation. Conclusion: The concept of bridging patients presenting in end-stage heart failure and cardiogenic shock with ECLS prior to durable LVAD implantation is a feasible method to ensure acceptable survival rates and significant recovery of the end-organ function.


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