Chapter 72 - Ventricular assist devices and cardiac transplantation

Summary

Cardiac transplantation and ventricular assist device therapy have become effective therapeutic options for patients with end-stage heart failure. Unfortunately, due to the shortage of organ donors, the annual number of heart transplants in the USA has remained relatively constant, between 2,200 and 2,400.

The development of implantable left ventricular assist devices (LVADs) for use as mechanical circulatory support also spanned several decades, dating back to the 1960s. However, LVADs were only applied for clinical use on a more routine basis in the mid 1980s. Since then, research and development of VAD technology continues to advance as the clinical experience with LVADs evolves over time. The number of LVADs being implanted in the USA continues to grow, with more than 1,000 devices implanted annually.

Heart transplantation and VAD therapy are complementary forms of therapy. Patient selection for both requires extensive evaluation by a multidisciplinary team. Transplantation is reserved for a group of patients with end-stage heart disease not amenable to optimal medical or surgical therapies. The indications for heart transplantation include patients with symptomatic New York Heart Association (NYHA) class III to IV heart failure despite optimal medical therapy, inability to wean from inotropic therapy, poor functional status on exercise testing, refractory ventricular arrhythmia, severe coronary artery disease with poor short-term prognosis, or complications of congenital heart disease that are refractory to medical and surgical intervention.