Controversies and Challenges of Ventricular Assist Device Therapy

Am J Cardiol. 2018 May 15;121(10):1219-1224. doi: 10.1016/j.amjcard.2018.01.034. Epub 2018 Feb 13.


Left ventricular assist device (LVAD) therapy has emerged as an increasingly vital facet of the treatment algorithm for advanced heart failure. Growing experience with LVAD support has led to substantial improvements in outcomes, with 1-year survival rates approaching that of cardiac transplantation. These therapeutic refinements have engendered growing interests in the potential for expanding the clinical indications for LVAD therapy to patients with less advanced heart failure. The primary obstacles to this evolution of care center largely on the prevention and/or management of the adverse events associated with LVAD therapy along with patient preference. Many programs also face the mounting difficulty of balancing quality outcomes with the increased volume of implants. During the recently assembled Users Meeting organized by St. Jude Medical, heart failure clinicians from nearly 50 LVAD implanting centers discussed these and other challenges and controversies impacting the field. The present review summarizes the key insights gleaned from this meeting.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Arrhythmias, Cardiac / epidemiology
  • Arrhythmias, Cardiac / prevention & control
  • Blood Pressure Monitors
  • Frailty
  • Gastrointestinal Hemorrhage / epidemiology
  • Gastrointestinal Hemorrhage / prevention & control
  • Heart Failure / therapy*
  • Heart Transplantation
  • Heart-Assist Devices*
  • Humans
  • Laser-Doppler Flowmetry
  • Patient Selection
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control
  • Recovery of Function
  • Severity of Illness Index
  • Thrombosis / epidemiology
  • Thrombosis / prevention & control
  • Ventricular Dysfunction, Right / epidemiology
  • Ventricular Dysfunction, Right / prevention & control
  • Ventricular Remodeling