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Ventricular assist devices.

Edith Collard¹, Michel J Van Dyck, Luc M Jacquet

¹Department of Anaesthesiology, Université Catholique de Louvain, Belgium. collard@anes.ucl.ac.be

Current Opinion in Anaesthesiology

|October 6, 2006

Summary

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Ventricular assist devices (VADs) offer new hope for end-stage heart failure, acting as bridges to transplant or recovery, and even long-term therapy. While complications persist, newer fully implantable VADs show promise for improved outcomes.

Area of Science:

Cardiology
Biomedical Engineering
Heart Failure Management

Background:

Ventricular assist devices (VADs) have seen significant technological advancements and expanded indications.
Understanding of myocardial recovery mechanisms following VAD support has improved.

Purpose of the Study:

To review recent technological progress in VADs.
To discuss new indications for VAD implantation, including permanent therapy.
To explore advancements in understanding myocardial recovery with VAD support.

Main Methods:

Review of technological developments in pulsatile and continuous flow pumps.
Analysis of new clinical indications for VADs.
Examination of research on hemodynamic, cellular, molecular, and electrophysiological effects of VADs.

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Main Results:

Development of fully implantable axial and centrifugal flow pumps.
VADs are increasingly used as permanent treatment for end-stage heart failure.
Mechanical assistance improves hemodynamics and cardiac function, suggesting potential for myocardial recovery.
High complication rates including device failure, bleeding, thromboembolism, and infection remain a concern.

Conclusions:

VADs serve as bridges to transplantation or recovery and are considered long-term myocardial replacement.
The optimal VAD for specific indications requires further definition.
Fully implantable VADs show promise for efficacy, reliability, and reduced complications.
Anesthesiologists must be prepared for VAD patients undergoing surgery.