Left Ventricular Assist Devices A Rapidly Evolving Alternative to Transplant

AbstractLeft ventricular assist devices are becoming an increasingly prevalent therapy for patients with Stage D heart failure with reduced ejection fraction. Technological advances have improved the durability of these devices and have significantly lengthened survival in these patients. Quality of life is also improved, although adverse events related to device therapy remain common. Nevertheless, with the continuing organ donor shortage for cardiac transplantation, left ventricular assist devices are frequently serving as a substitute for transplant, particularly in the elderly patient

Heart Transplantation in the Era of the Left Ventricular Assist Devices

Orthotopic heart transplant is recognized as the gold standard for the treatment of end-stage heart disease. However, there is a perennial shortage of donor organs. Left ventricular assist devices (LVAD) represent a revolutionary tool for temporizing heart failure that is refractory to medical management until a suitable organ becomes available. This review highlights the LVAD as a tool for bridging to transplant. The history of the LVAD and its use in heart transplantation is described, as well as the current indications for use in the general heart transplant candidate as well as for selected subpopulations. It also highlights the major complications of LVAD use, advancements in the field, and selected current controversies related to the LVAD as bridge-to-transplant therapy

Primary graft dysfunction after heart transplantation: a thorn amongst the roses

Primary graft dysfunction (PGD) remains the leading cause of early mortality post-heart transplantation. Despite improvements in mechanical circulatory support and critical care measures, the rate of PGD remains significant. A recent consensus statement by the International Society of Heart and Lung Transplantation (ISHLT) has formulated a definition for PGD. Five years on, we look at current concepts and future directions of PGD in the current era of transplantation