To ventricular assist devices or not: When is implantation of a ventricular assist device appropriate in advanced ambulatory heart failure?

Abstract

Advanced heart failure has been traditionally treated via either heart transplantation, continuous inotropes, consideration for hospice and more recently via left ventricular assist devices (LVAD). Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure. Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure. The question of when to implant these devices in those patients with advanced, yet still ambulatory heart failure remains a controversial topic. We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure.

Keywords: Left ventricular assist device; Mechanical circulatory support; Heart failure; Cardiomyopathy; Diastolic dysfunction

Core tip: Heart failure remains the most common diagnosis in patients discharged from the hospital. In its most advanced stages, it bears a grim prognosis and there are only a limited number of treatments that can truly change the course of the disease. Advancements in left ventricular assist device technology have enticed clinicians to expand their role in earlier ambulatory, but advanced heart failure. Here, we describe the current equilibrium between early implantation and risks of the current technology.