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Long-term left-ventricular-assist-device therapy is here to stay

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 60–61 (2008)Cite this article

The quest for the development of a totally implantable artificial heart continues to intrigue, challenge, and elude attempts at making it a clinical reality. The closely related field of left-ventricular-assist-device (LVAD) therapy has, however, been making steady and impressive progress, stimulated both by the immense global need for these devices and commercial interest. An estimated 16 million individuals suffer from heart failure (HF) in Europe and the US alone. This number is expected to rise considerably over the next 20 years because of the steady increase in life expectancy—the prevalence of HF in people over the age of 60 years can be as high as 17%.1 Severe forms of HF, which occur in approximately 6% of all affected patients, are progressive, and resistant to medical therapy, with cardiac transplantation being the only effective treatment available. Currently, however, trans-plantation is, and in the absence of xenotransplantation will remain, markedly limited by the gross shortage of donors, thus, creating a niche for LVADs. The capacity of these devices to realize their full potential depends to a large extent on the answer to the question 'are LVADs ready for long-term use?' Addressing this issue requires a thorough understanding of the efficacy and durability of the available devices and the rate of associated complications, in combination with refinement of the timing and indications for insertion of LVADs on the basis of validated predictors (including biochemical and genetic markers,2 and indicators of deteriorating renal or hepatic function secondary to severe HF). Unfortunately, because these factors are interdependent and constantly evolving, there is often a time lag between new data being generated and that data becoming available to practicing clinicians and decision makers. In this Viewpoint, we will attempt to assess the feasibility of long-term LVAD use and outline areas for future research. In addition, we suggest a therapeutic decision-making process that can be easily adapted in response to constant progress.

The concept of LVAD therapy evolved as a reductionist approach to prolonged support of the circulation by mechanical pump, from heart and lung bypass using extracorporeal membrane oxygenators, to biventricular support, and finally to LVADs that pump blood from the apex of the left ventricle (LV) to the aorta. In early procedures, the pumps were placed outside the body, but more recently they have been implanted, with a drive line through the skin. The latter approach improves the patient's mobility and their capacity to lead a relatively normal life outside hospital during the period of LV support.

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Authors and Affiliations

  1. MH Yacoub is Professor of Cardiac Surgery at Imperial College London, and Director of Research at the Harefield Heart Science Centre, Harefield, UK,

    Magdi H Yacoub

  2. and is Chief of the Integrated Divisions of Cardiology at Georgetown University Hospital and Washington Hospital Center, LW Miller holds the Walters Chair in Cardiology at Georgetown University School of Medicine, Washington, DC, USA.,

    Leslie W Miller

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  1. Magdi H Yacoub
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  2. Leslie W Miller
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Correspondence to Magdi H Yacoub.

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The authors declare no competing financial interests.

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Yacoub, M., Miller, L. Long-term left-ventricular-assist-device therapy is here to stay. Nat Rev Cardiol 5, 60–61 (2008). https://doi.org/10.1038/ncpcardio1067

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