Cardiac Assist Devices

  • Basel RamlawiEmail author
Conference paper


Heart failure is the inability of the heart to pump blood at a rate ­commensurate with the requirements of the metabolizing tissues. This growing population of patients with refractory end-stage heart failure has been a major catalyst for the development of devices that assist or even replace the failing heart. The concept of using left-ventricular assist devices (LVADs) as the means of permanent therapy is based on the success of their use in heart transplant candidates, who developed refractory heart failure and were ‘bridged’ to transplantation with LVADs. VAD technology will need to achieve several important milestones to significantly minimize associated complications, improve outcomes and quality of life while reducing cost. This chapter will discuss the current and future directions of cardiac assist devices.


Continuous flow pumps Heart failure Left ventricular assist device Mechanical circulatory support Pulsatile pumps Transplantation 


  1. 1.
    Massad MG (2004) Surgical options for the management of congestive heart failure. Cardiology 101:5–6CrossRefGoogle Scholar
  2. 2.
    Massad MG, Prasad SM, Chedrawy EG, Lele H (2008) A perspective on the surgical management of congestive heart failure. World J Surg 32:375–380CrossRefGoogle Scholar
  3. 3.
    Stevenson LW (2003) Clinical use of inotropic therapy for heart failure: looking backward or forward? Part I: inotropic infusions during hospitalization. Circulation 108:367–372CrossRefGoogle Scholar
  4. 4.
    Stevenson LW (2003) Clinical use of inotropic therapy for heart failure: looking backward or forward? Part II: chronic inotropic therapy. Circulation 108:492–497CrossRefGoogle Scholar
  5. 5.
    Westaby S, Frazier OH, Banning A (2006) Six years of continuous mechanical circulatory support. N Engl J Med 355:325–327CrossRefGoogle Scholar
  6. 6.
    Mather PJ, Konstam MA (2007) Newer mechanical devices in the management of acute heart failure. Heart Fail Rev 12:167–172CrossRefGoogle Scholar
  7. 7.
    Aggarwal S, Cheema F, MC OZ, Naka Y (2007) Long-term mechanical circulatory support. In: Cohn L (ed) Cardiac surgery in the adult. McGraw-Hill, New York, pp 1634–1652Google Scholar
  8. 8.
    Norman JC, Cooley DA, Igo SR, Hibbs CW, Johnson MD, Bennett JG, Fuqua JM, Trono R, Edmonds CH (1977) Prognostic indices for survival during postcardiotomy intra-aortic ­balloon pumping. Methods of scoring and classification, with implications for left ventricular assist device utilization. J Thorac Cardiovasc Surg 74:709–720Google Scholar
  9. 9.
    Aaronson KD, Patel H, Pagani FD (2003) Patient selection for left ventricular assist device therapy. Ann Thorac Surg 75:S29–S35CrossRefGoogle Scholar
  10. 10.
    Califf RM, Bengtson JR (1994) Cardiogenic shock. N Engl J Med 330:1724–1730CrossRefGoogle Scholar
  11. 11.
    Frazier OH, Rose EA, McCarthy P, Burton NA, Tector A, Levin H, Kayne HL, Poirier VL, Dasse KA (1995) Improved mortality and rehabilitation of transplant candidates treated with a long-term implantable left ventricular assist system. Ann Surg 222:327–336, discussion 336–328CrossRefGoogle Scholar
  12. 12.
    Goldberg RJ, Samad NA, Yarzebski J, Gurwitz J, Bigelow C, Gore JM (1999) Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 340:1162–1168CrossRefGoogle Scholar
  13. 13.
    Holman WL, Roye GD, Bourge RC, McGiffin DC, Iyer SS, Kirklin JK (1995) Circulatory support for myocardial infarction with ventricular arrhythmias. Ann Thorac Surg 59:1230–1231CrossRefGoogle Scholar
  14. 14.
    Noda H, Takano H, Taenaka Y, Nakatani T, Umezu M, Kinoshita M, Tatsumi E, Yagura A, Sekii H, Kito Y et al (1989) Treatment of acute myocardial infarction with cardiogenic shock using left ventricular assist device. Int J Artif Organs 12:175–179Google Scholar
  15. 15.
    Oz MC, Rose EA, Slater J, Kuiper JJ, Catanese KA, Levin HR (1994) Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices. J Am Coll Cardiol 24:1688–1691CrossRefGoogle Scholar
  16. 16.
    Williams MR, Oz MC (2001) Indications and patient selection for mechanical ventricular assistance. Ann Thorac Surg 71:S86–S91, discussion S114–S115CrossRefGoogle Scholar
  17. 17.
    Hands ME, Rutherford JD, Muller JE, Davies G, Stone PH, Parker C, Braunwald E (1989) The in-hospital development of cardiogenic shock after myocardial infarction: incidence, predictors of occurrence, outcome and prognostic factors. The MILIS Study Group. J Am Coll Cardiol 14:40–46, discussion 47–48CrossRefGoogle Scholar
  18. 18.
    DeRose JJ Jr, Umana JP, Argenziano M, Catanese KA, Levin HR, Sun BC, Rose EA, Oz MC (1997) Improved results for postcardiotomy cardiogenic shock with the use of implantable left ventricular assist devices. Ann Thorac Surg 64:1757–1762, discussion 1762–1753CrossRefGoogle Scholar
  19. 19.
    Dang NC, Topkara VK, Kim BT, Mercando ML, Kay J, Naka Y (2005) Clinical outcomes in patients with chronic congestive heart failure who undergo left ventricular assist device implantation. J Thorac Cardiovasc Surg 130:1302–1309CrossRefGoogle Scholar
  20. 20.
    Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, Conte JV, Naka Y, Mancini D, Delgado RM, MacGillivray TE, Farrar DJ, Frazier OH (2007) Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 357:885–896CrossRefGoogle Scholar
  21. 21.
    Chen JM, Spanier TB, Gonzalez JJ, Marelli D, Flannery MA, Tector KA, Cullinane S, Oz MC (1999) Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance. J Heart Lung Transplant 18:351–357CrossRefGoogle Scholar
  22. 22.
    Schulman AR, Martens TP, Christos PJ, Russo MJ, Comas GM, Cheema FH, Naseem TM, Wang R, Idrissi KA, Bailey SH, Naka Y (2007) Comparisons of infection complications between continuous flow and pulsatile flow left ventricular assist devices. J Thorac Cardiovasc Surg 133:841–842CrossRefGoogle Scholar
  23. 23.
    Dasse KA, Gellman B, Kameneva MV, Woolley JR, Johnson CA, Gempp T, Marks JD, Kent S, Koert A, Richardson JS, Franklin S, Snyder TA, Wearden P, Wagner WR, Gilbert RJ, Borovetz HS (2007) Assessment of hydraulic performance and biocompatibility of a MagLev centrifugal pump system designed for pediatric cardiac or cardiopulmonary support. ASAIO J 53:771–777CrossRefGoogle Scholar
  24. 24.
    Terracciano CM, Miller LW, Yacoub MH (2010) Contemporary use of ventricular assist devices. Annu Rev Med 61:255–270CrossRefGoogle Scholar
  25. 25.
    Henriques JP, Remmelink M, Baan J Jr, van der Schaaf RJ, Vis MM, Koch KT, Scholten EW, de Mol BA, Tijssen JG, Piek JJ, de Winter RJ (2006) Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover LP 2.5. Am J Cardiol 97:990–992CrossRefGoogle Scholar
  26. 26.
    Thiele H, Lauer B, Hambrecht R, Boudriot E, Cohen HA, Schuler G (2001) Reversal of ­cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation 104:2917–2922CrossRefGoogle Scholar
  27. 27.
    Henriques JP, de Mol BA (2008) New percutaneous mechanical left ventricular support for acute MI: the AMC MACH program. Nat Clin Pract Cardiovasc Med 5:62–63CrossRefGoogle Scholar
  28. 28.
    Greenberg B, Czerska B, Delgado RM, Bourge R, Zile MR, Silver M, Klapholz M, Haeusslein E, Mehra MR, Mather P, Abraham WT, Neaton JD, Brown BS, Parker IC, Konstam MA (2008) Effects of continuous aortic flow augmentation in patients with exacerbation of heart failure inadequately responsive to medical therapy: results of the Multicenter Trial of the Orqis Medical Cancion System for the Enhanced Treatment of Heart Failure Unresponsive to Medical Therapy (MOMENTUM). Circulation 118:1241–1249CrossRefGoogle Scholar
  29. 29.
    John R, Liao K, Lietz K, Kamdar F, Colvin-Adams M, Boyle A, Miller L, Joyce L (2007) Experience with the Levitronix CentriMag circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock and multisystem organ failure. J Thorac Cardiovasc Surg 134:351–358CrossRefGoogle Scholar
  30. 30.
    Birks EJ, Tansley PD, Yacoub MH, Bowles CT, Hipkin M, Hardy J, Banner NR, Khaghani A (2004) Incidence and clinical management of life-threatening left ventricular assist device failure. J Heart Lung Transplant 23:964–969CrossRefGoogle Scholar
  31. 31.
    Pagani FD, Long JW, Dembitsky WP, Joyce LD, Miller LW (2006) Improved mechanical reliability of the HeartMate XVE left ventricular assist system. Ann Thorac Surg 82:1413–1418CrossRefGoogle Scholar
  32. 32.
    Pagani FD, Miller LW, Russell SD, Aaronson KD, John R, Boyle AJ, Conte JV, Bogaev RC, MacGillivray TE, Naka Y, Mancini D, Massey HT, Chen L, Klodell CT, Aranda JM, Moazami N, Ewald GA, Farrar DJ, Frazier OH (2009) Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol 54:312–321CrossRefGoogle Scholar
  33. 33.
    Lietz K, Miller LW (2005) Will left-ventricular assist device therapy replace heart transplantation in the foreseeable future? Curr Opin Cardiol 20:132–137Google Scholar
  34. 34.
    Mitter N, Sheinberg R (2010) Update on ventricular assist devices. Curr Opin Anaesthesiol 23:57–66CrossRefGoogle Scholar
  35. 35.
    Morshuis M, El-Banayosy A, Arusoglu L, Koerfer R, Hetzer R, Wieselthaler G, Pavie A, Nojiri C (2009) European experience of DuraHeart magnetically levitated centrifugal left ventricular assist system. Eur J Cardiothorac Surg 35:1020–1027, discussion 1027–1028CrossRefGoogle Scholar
  36. 36.
    Tuzun E, Roberts K, Cohn WE, Sargin M, Gemmato CJ, Radovancevic B, Frazier OH (2007) In vivo evaluation of the HeartWare centrifugal ventricular assist device. Tex Heart Inst J 34:406–411Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Methodist DeBakey Heart and Vascular Center, Cardiovascular Surgery and TransplantationThe Methodist HospitalHoustonUSA

Personalised recommendations