Concomitant Cardiac Surgery During VAD Placement: When Is It Too Much?

Abstract

The aging of the global population has ushered in a new medical era where management of chronic degenerative diseases is becoming increasingly important. The growing global pandemic of heart failure is one component of that problem and remains, in the USA, as one of the most expensive to treat. To date, the treatments for terminal stages of heart failure are comfort care, cardiac transplantation, and support using ventricular assist devices. The overall impact of cardiac transplantation on the epidemiology of heart failure is “trivial” [1]. This shortcoming has placed greater emphasis on the use of mechanical devices to sustain patients. Initially, devices were used to support patients awaiting heart transplantation, but the ever-present shortage and the growing population prompted their use as permanent devices or “destination therapy.” In the 1980s, survival on a device for days was considered to be exemplary. In the 1990s, weeks of survival were an improvement, and in the 2000 era, a survival of months was considered to be unique.