Past, present, and future of long-term mechanical cardiac support in adults

The growing number of heart failure patients and the scarcity of donor organs give rise to the development of mechanical circulatory support devices for a long-term support. After approximately 15 years of experience, these devices should be critically evaluated. The presented article gives an overview on the currently most often used mechanical circulatory support systems, describes the indications for implantation (bridge to cardiac transplantation, destination therapy, and bridge to recovery), the complications like bleeding, thromboembolic events, infections, and technical failures, and analyzes the costs of this therapy. Furthermore, alternative treatment options like cardiac transplantation, coronary artery bypass grafting, cardiac valve surgery, defibrillator implantation, multisite pacing, dynamic and passive cardiomyoplasty, partial left ventriculectomy (PLV), Myosplint implantation (Myocor, Maple Grove, MN, USA), stem cell therapy, and xenotransplantation are shortly presented, and the future of mechanical support devices is discussed. Despite a great number of patients benefitting from mechanical support devices, the treatment with these devices will only compete with other therapeutic strategies if the rates of complications and technical failures as well as the costs are significantly reduced. Furthermore, innovative therapies like biochemical influencing of the cardiac metabolism have a high potential and may play an important role in the future.