Korean Circ J.  2019 Jul;49(7):568-585. 10.4070/kcj.2019.0161.

Left Ventricular Assist Devices (LVADS): History, Clinical Application and Complications

Affiliations
  • 1Heart and Vascular Institute, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA.

Abstract

Congestive heart failure is a major cause of morbidity and mortality as well as a major health care cost in the developed world. Despite the introduction of highly effective heart failure medical therapies and simple devices such as cardiac resynchronization therapy that reduce mortality, improve cardiac function and quality of life, there remains a large number of patients who do not respond to these therapies or whose heart failure progresses despite optimal therapy. For these patients, cardiac transplantation is an option but is limited by donor availability as well as co-morbidities which may limit survival post-transplant. For these patients, left ventricular assist devices (LVADs) offer an alternative that can improve survival as well as exercise tolerance and quality of life. These devices have continued to improve as technology has improved with substantially improved durability of the devices and fewer post-implant complications. Pump thrombosis, stroke, gastrointestinal bleeding and arrhythmias post-implant have become less common with the newest devices, making destination therapy where ventricular assist device are implanted permanently in patients with advanced heart failure, a reality and an appropriate option for many patients. This may offer an opportunity for long term survival in many patients. As the first of the totally implantable devices are introduced and go to clinical trials, LVADs may be introduced that may truly be alternatives to cardiac transplantation in selected patients. Post-implant right ventricular failure remains a significant complication and better ways to identify patients at risk as well as to manage this complication must be developed.

Keyword

Congestive heart failure; Circulatory shock; Ventricular assist device; Pumps, heartassist; Cardiac transplantation

MeSH Terms

Arrhythmias, Cardiac
Cardiac Resynchronization Therapy
Exercise Tolerance
Health Care Costs
Heart Failure
Heart Transplantation
Heart-Assist Devices*
Hemorrhage
Humans
Mortality
Quality of Life
Stroke
Thrombosis
Tissue Donors

Figure

  • Figure 1 The prototype of the first left ventricular assist device which became the Thoratec XVE and the HeartMate (with appreciation to Gerson Rosenberg, PhD, Professor of Artificial Organs, Pennsylvania State University, Hershey, Pennsylvania).


Cited by  1 articles

Economic Burden of Heart Failure in Asian Countries Based on Real-world Data
Hyemoon Chung, Il Suk Sohn
Korean Circ J. 2021;51(8):694-695.    doi: 10.4070/kcj.2021.0197.


Reference

1. Centers for Disease Control and Prevention. Heart failure fact sheet [Internet]. Atlanta: Centers for Disease Control and Prevention;2019. cited 2019 April 30. Available from https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm.
2. Patel CB, Rogers JG. Durable mechanical circulatory support devices. Prog Cardiovasc Dis. 2011; 54:132–143.
3. Stewart GC, Givertz MM. Mechanical circulatory support for advanced heart failure: patients and technology in evolution. Circulation. 2012; 125:1304–1315.
4. Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med. 1954; 37:171–185.
5. Frazier OH. Mechanical cardiac assistance: historical perspectives. Semin Thorac Cardiovasc Surg. 2000; 12:207–219.
6. Hogness JR, VanAntwerp M, editors. The artificial heart: prototypes, policies, and patients. . Washington, D.C.: National Academy Press (US);1991.
7. Stewart GC, Mehra MR. A history of devices as an alternative to heart transplantation. Heart Fail Clin. 2014; 10:S1–12.
8. Cooper DK. Christiaan Barnard-The surgeon who dared: the story of the first human-to-human heart transplant. Glob Cardiol Sci Pract. 2018; 2018:11.
9. Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001; 345:1435–1443.
10. Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007; 357:885–896.
11. Lok SI, Martina JR, Hesselink T, et al. Corrigendum to “Single-centre experience of 85 patients with a continuous-flow left ventricular assist device: clinical practice and outcome after extended support” [Eur J Cardiothorac Surg 2013;44:e233-8]. Eur J Cardiothorac Surg. 2014; 45:400.
12. Slaughter MS, Rogers JG, Milano CA, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009; 361:2241–2251.
13. Pagani FD, Milano CA, Tatooles AJ, et al. HeartWare HVAD for the treatment of patients with advanced heart failure ineligible for cardiac transplantation: results of the ENDURANCE destination therapy trial. J Heart Lung Transplant. 2015; 34:S9.
14. WRITING COMMITTEE MEMBERS. Yancy CW, Jessup M, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013; 128:e240–327.
15. Miller LW, Guglin M. Patient selection for ventricular assist devices: a moving target. J Am Coll Cardiol. 2013; 61:1209–1221.
16. Kirklin JK, Naftel DC, Stevenson LW, et al. INTERMACS database for durable devices for circulatory support: first annual report. J Heart Lung Transplant. 2008; 27:1065–1072.
17. Cai AW, Islam S, Hankins SR, Fischer W, Eisen HJ. Mechanical circulatory support in the treatment of advanced heart failure. Am J Transplant. 2017; 17:3020–3032.
18. Birks EJ, Tansley PD, Hardy J, et al. Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med. 2006; 355:1873–1884.
Article
19. Drakos SG, Kfoury AG, Stehlik J, et al. Bridge to recovery: understanding the disconnect between clinical and biological outcomes. Circulation. 2012; 126:230–241.
20. Drakos SG, Mehra MR. Clinical myocardial recovery during long-term mechanical support in advanced heart failure: insights into moving the field forward. J Heart Lung Transplant. 2016; 35:413–420.
Article
21. Kirklin JK, Naftel DC, Pagani FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015; 34:1495–1504.
Article
22. Ambardekar AV, Forde-McLean RC, Kittleson MM, et al. High early event rates in patients with questionable eligibility for advanced heart failure therapies: results from the Medical Arm of Mechanically Assisted Circulatory Support (Medamacs) Registry. J Heart Lung Transplant. 2016; 35:722–730.
Article
23. Estep JD, Starling RC, Horstmanshof DA, et al. Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: results from the ROADMAP study. J Am Coll Cardiol. 2015; 66:1747–1761.
24. Starling RC, Estep JD, Horstmanshof DA, et al. Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: the ROADMAP study 2-year results. JACC Heart Fail. 2017; 5:518–527.
25. Hayek S, Sims DB, Markham DW, Butler J, Kalogeropoulos AP. Assessment of right ventricular function in left ventricular assist device candidates. 2014; 7:379–389.
Article
26. Holman WL, Acharya D, Siric F, Loyaga-Rendon RY. Assessment and management of right ventricular failure in left ventricular assist device patients. Circ J. 2015; 79:478–486.
Article
27. Bellavia D, Iacovoni A, Scardulla CA, et al. Prediction of right ventricular failure after ventricular assist device implant: systematic review and meta-analysis of observational studies. Eur J Heart Fail. 2017; 19:926–946.
Article
28. Houston BA, Shah KB, Mehra MR, Tedford RJ. A new “twist” on right heart failure with left ventricular assist systems. J Heart Lung Transplant. 2017; 36:701–707.
Article
29. Aissaoui N, Salem JE, Paluszkiewicz L, et al. Assessment of right ventricular dysfunction predictors before the implantation of a left ventricular assist device in end-stage heart failure patients using echocardiographic measures (ARVADE): combination of left and right ventricular echocardiographic variables. 2015; 108:300–309.
Article
30. Khazanie P, Rogers JG. Patient selection for left ventricular assist devices. Congest Heart Fail. 2011; 17:227–234.
Article
31. Aggarwal A, Pant R, Kumar S, et al. Incidence and management of gastrointestinal bleeding with continuous flow assist devices. Ann Thorac Surg. 2012; 93:1534–1540.
Article
32. Marsano J, Desai J, Chang S, Chau M, Pochapin M, Gurvits GE. Characteristics of gastrointestinal bleeding after placement of continuous-flow left ventricular assist device: a case series. Dig Dis Sci. 2015; 60:1859–1867.
Article
33. Draper K, Huang RJ, Gerson LB. Gastrointestinal bleeding in patients with continuous-flow left-ventricular assist devices: a systematic review and meta-analysis. Gastroenterology. 2014; 146:S-558.
34. Balcioglu O, Engin C, Yagdi T, et al. Effect of aortic valve movements on gastrointestinal bleeding that occured in continuous flow left ventricular assist device patients. Transplant Proc. 2013; 45:1020–1021.
Article
35. Kim JH, Brophy DF, Shah KB. Continuous-flow left ventricular assist device-related gastrointestinal bleeding. Cardiol Clin. 2018; 36:519–529.
Article
36. Pichiule P, Chavez JC, LaManna JC. Hypoxic regulation of angiopoietin-2 expression in endothelial cells. J Biol Chem. 2004; 279:12171–12180.
Article
37. Yamakawa M, Liu LX, Date T, et al. Hypoxia-inducible factor-1 mediates activation of cultured vascular endothelial cells by inducing multiple angiogenic factors. Circ Res. 2003; 93:664–673.
Article
38. Hayes HM, Dembo LG, Larbalestier R, O'Driscoll G. Management options to treat gastrointestinal bleeding in patients supported on rotary left ventricular assist devices: a single-center experience. Artif Organs. 2010; 34:703–706.
Article
39. Seng BJ, Teo LL, Chan LL, et al. Novel use of low-dose thalidomide in refractory gastrointestinal bleeding in left ventricular assist device patients. Int J Artif Organs. 2017; 40:636–640.
Article
40. Vukelic S, Vlismas PP, Patel SR, et al. Digoxin is associated with a decreased incidence of angiodysplasia-related gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices. Circ Heart Fail. 2018; 11:e004899.
Article
41. Uriel N, Pak SW, Jorde UP, et al. Acquired von Willebrand syndrome after continuous-flow mechanical device support contributes to a high prevalence of bleeding during long-term support and at the time of transplantation. J Am Coll Cardiol. 2010; 56:1207–1213.
Article
42. McIlvennan CK, Magid KH, Ambardekar AV, Thompson JS, Matlock DD, Allen LA. Clinical outcomes after continuous-flow left ventricular assist device: a systematic review. Circ Heart Fail. 2014; 7:1003–1013.
43. Tsiouris A, Paone G, Nemeh HW, et al. Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices. World J Cardiol. 2015; 7:792–800.
Article
44. Harvey L, Holley C, Roy SS, et al. Stroke after left ventricular assist device implantation: outcomes in the continuous-flow era. Ann Thorac Surg. 2015; 100:535–541.
Article
45. Kimura M, Kinoshita O, Nawata K, et al. Midterm outcome of implantable left ventricular assist devices as a bridge to transplantation: single-center experience in Japan. J Cardiol. 2015; 65:383–389.
Article
46. INTERMACS. Initial analyses of suspected pump thrombosis [Internet]. Birmingham: University of Alabama at Birmingham (UAB) School of Medicine;2013. cited 2016 February 1. Available from https://www.uab.edu/medicine/intermacs/images/INTERMACS_PI_and_Website_Notice_9-6-2013_2.pdf.
47. Schmitto JD, Avsar M, Haverich A. Increase in left ventricular assist device thrombosis. N Engl J Med. 2014; 370:1463–1464.
Article
48. Maltais S, Kilic A, Nathan S, et al. PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management: The PREVENT multi-center study. J Heart Lung Transplant. 2017; 36:1–12.
Article
49. Klodell CT, Massey HT, Adamson RM, et al. Factors related to pump thrombosis with the HeartMate II left ventricular assist device. J Card Surg. 2015; 30:775–780.
Article
50. Martin SI. Infectious complications of mechanical circulatory support (MCS) devices. Curr Infect Dis Rep. 2013; 15:472–477.
Article
51. Pedrotty DM, Rame JE, Margulies KB. Management of ventricular arrhythmias in patients with ventricular assist devices. Curr Opin Cardiol. 2013; 28:360–368.
Article
52. Bennett MK, Adatya S. Blood pressure management in mechanical circulatory support. J Thorac Dis. 2015; 7:2125–2128.
53. Uriel N, Morrison KA, Garan AR, et al. Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: the Columbia ramp study. J Am Coll Cardiol. 2012; 60:1764–1775.
54. Narang N, Raikhelkar J, Sayer G, Uriel N. Hemodynamic pump-patient interactions and left ventricular assist device imaging. Cardiol Clin. 2018; 36:561–569.
Article
55. Rosenbaum AN, Frantz RP, Kushwaha SS, Stulak JM, Maltais S, Behfar A. Novel left heart catheterization ramp protocol to guide hemodynamic optimization in patients supported with left ventricular assist device therapy. J Am Heart Assoc. 2019; 8:e010232.
Article
56. Uriel N, Sayer G, Addetia K, et al. Hemodynamic ramp tests in patients with left ventricular assist devices. JACC Heart Fail. 2016; 4:208–217.
57. Mehra MR, Naka Y, Uriel N, et al. A fully magnetically levitated circulatory pump for advanced heart failure. N Engl J Med. 2017; 376:440–450.
Article
58. Mehra MR, Goldstein DJ, Uriel N, et al. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med. 2018; 378:1386–1395.
Article
59. Mehra MR, Uriel N, Naka Y, et al. MOMENTUM 3 Investigators. A fully magnetically levitated left ventricular assist device - final report. N Engl J Med. 2019; 380:1618–1627.
60. Dowling RD, Etoch SW, Stevens K, et al. Initial experience with the AbioCor implantable replacement heart at the University of Louisville. ASAIO J. 2000; 46:579–581.
Article
61. Mehta SM, Silber D, Boehmer JP, Christensen D, Pae WE Jr. Report of the first U.S. patient successfully supported long term with the LionHeart completely implantable left ventricular assist device system. ASAIO J. 2006; 52:e31–2.
Article
62. Pae WE, Connell JM, Adelowo A, et al. Does total implantability reduce infection with the use of a left ventricular assist device? The LionHeart experience in Europe. J Heart Lung Transplant. 2007; 26:219–229.
Article
63. Michael Zilbershlag. CEO Leviticus Cardio, Personal communication.
64. Kransdorf EP, Mehta HS, Shah KB, et al. ISHLT transplant registry: youthful investment-the path to progress. J Heart Lung Transplant. 2017; 36:1027–1036.
Article
65. Yusen RD, Edwards LB, Kucheryavaya AY, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-first adult lung and heart-lung transplant report--2014; focus theme: retransplantation. J Heart Lung Transplant. 2014; 33:1009–1024.
Article
66. Stehlik J, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report--2012. J Heart Lung Transplant. 2012; 31:1052–1064.
Article
67. Eisen HJ, Tuzcu EM, Dorent R, et al. Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients. N Engl J Med. 2003; 349:847–858.
Article
68. Eisen HJ, Hasni SF, Wang D. The return of the mTOR Inhibitors: getting it right in patients after cardiac transplantation. J Am Coll Cardiol. 2018; 71:651–653.
69. Kauffman HM, Cherikh WS, Cheng Y, Hanto DW, Kahan BD. Maintenance immunosuppression with target-of-rapamycin inhibitors is associated with a reduced incidence of de novo malignancies. Transplantation. 2005; 80:883–889.
Full Text Links
  • KCJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr