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Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
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Ethical Considerations in the Long-Term Ventricular Assist Device Patient
Amanda Cai1,2, Howard J Eisen3,4
1Department of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.
Current Heart Failure Reports
|February 18, 2017
Summary
Ventricular assist devices (VADs) improve survival for end-stage heart failure patients but pose ethical challenges. Examining autonomy, beneficence, non-maleficence, and justice is crucial for long-term VAD care.
Area of Science:
- Cardiology
- Medical Ethics
- Biomedical Engineering
Background:
- The aging heart failure population necessitates advanced therapies like ventricular assist devices (VADs).
- VADs offer life extension and suffering alleviation for end-stage heart disease.
- Modern VADs demonstrate survival rates comparable to cardiac transplantation at one year.
Purpose of the Study:
- To ethically analyze long-term ventricular assist device (VAD) patient care.
- To examine the ethical principles of autonomy, beneficence, non-maleficence, and justice in VAD therapy.
Main Methods:
- Review of ethical principles applied to VAD implantation and management.
- Analysis of patient selection, treatment goals, and therapy duration.
- Evaluation of shared decision-making and multidisciplinary approaches.
Main Results:
- VAD implantation has improved survival, even for critically ill patients.
- VAD procedures carry significant risks, including up to 27% in-hospital mortality.
- End-of-life decisions are complex due to device dependency and potential for delayed death.
Conclusions:
- Ethical considerations are paramount for effective VAD therapy and resource allocation.
- Advanced directives, shared decision-making, and multidisciplinary care enhance VAD patient outcomes.
- Optimizing VAD therapy requires careful ethical deliberation regarding patient selection and treatment goals.
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