Mechanical circulatory support-results, developments and trends

The implantation of ventricular assist devices (VADs) is a valuable option in patients with end-stage heart failure. The number of VAD implantations is growing worldwide. Between July 1987 and July 2010, we implanted 1,598 VADs in 1,455 patients. The majority were male (81.0%), and their mean age was 49.4 years (range 0.3-82 years). Indications for implantation were: cardiomyopathy (n = 1,074), post-cardiotomy heart failure (n = 282), acute myocardial infarction (n = 83), graft failure after heart transplantation (n = 64), and others (n = 61). In 55.5%, the VAD implanted was left ventricular, in 39.5% biventricular, and in 4.8% right ventricular. Until 1995, the implanted pumps were mostly pulsatile. Today, however, more than 95% of the implanted VADs are continuous-flow rotary pumps. The average support time was 148.6 days (range 0-1,836 days). The percentage of biventricular VADs has dropped over the years to 20% in 2009. Three hundred forty-seven patients could be successfully bridged to heart transplantation. In 122 patients (8.3%), the device could be explanted after myocardial recovery. In 2009, 31.4% of the patients were implanted for permanent support. During the study period, 521 patients could be discharged home or to a rehabilitation center. Implantation of ventricular assist devices is now an established treatment for patients with both acute and chronic end-stage heart failure. Small implantable left ventricular assist devices of the second and third generation are now broadly employed worldwide, with growing acceptance and decreasing complications. The percentage of biventricular support has dropped over the years to 20%.