Patient selection for ventricular assist devices: a moving target.

Area of Science:

• Cardiology
• Medical Devices
• Mechanical Circulatory Support

Background:

• Increasing prevalence of advanced heart failure refractory to conventional medical therapy.
• Ventricular assist devices (VADs) emerge as a key alternative to heart transplantation.
• Lack of established national guidelines for VAD patient selection.

Purpose of the Study:

• To review general criteria for referring patients for VAD evaluation.
• To outline specific issues pertinent to patient selection for VADs.
• To provide guidance in the absence of formal national society-approved guidelines.

Main Methods:

• Review of current literature and technological advancements in mechanical circulatory support.
• Analysis of evolving criteria for patient selection for VAD implantation.
• Discussion of factors influencing the expanding role of VADs.

Main Results:

• Significant technological advancements have broadened the patient population eligible for VADs.
• Limitations related to age, body size, and comorbidities are becoming less prohibitive.
• VADs are increasingly viable compared to heart transplantation and medical management.

Conclusions:

• VAD technology is rapidly evolving, simplifying design and reducing device size.
• Future VAD use is expected to expand to less advanced heart failure cases.
• The outlined selection process will adapt to accommodate these technological shifts.