State of the art: implantable ventricular assist devices

The first generation of implantable pulsatile ventricular assist devices (VADs) has proven to be successful as bridge to transplantation. Adverse events such as mechanical failure and infections, however, limit their use for long-term support (>1 year) or as alternative for heart transplantation. Newer second generation of nonpulsatile VADs shows less of such limitations.

As bridge to transplantation, we have seen a switch from pulsatile volume-displacement devices, like the HeartMate XVE LVAS and Novacor left ventricular assist device (LVAD), (first generation) to continuous flow devices like the HeartMate 2 and Berlin Heart Incor (second generation). These devices are smaller, quiet and mechanically more durable. Better long-term survival, lower infection rates, excellent mechanical durability and acceptable quality of life together with shortage of donor organs led also to an increasing usage of these devices as alternative to transplantation. Recent studies show in this respect encouraging results, with actuarial survival rates at 1 and 2 years of 70% or higher. Another result of long-term cardiac support is a bridge to recovery. Initial results of even smaller implantable centrifugal pumps like the HeartWare VAD are promising.

An overview of recent developments in mechanical circulatory support is presented.