Abstract
Heart failure is a leading cause of death in developed countries, despite significant progress in medical management. Heart transplantation still remains the best therapy option for patients with end-stage heart failure, but it is limited by increased shortage of donor organs. Ventricular assist devices (VADs) with their variety (univentricular of biventricular support; extracorporeal or implantable; rotary or pulsatile) have become established surgical therapy for end-stage heart failure over the last decade. In patients with pronounced left ventricular failure, a left ventricular assist device support, where blood is bypassed from the left ventricular apex to the ascending aorta or descending aorta, is clinically efficient. When patients with advanced heart failure involving both ventricles become refractory to optimal medical therapy, biventricular mechanical circulatory support is required using biventricular VAD or a total artificial heart. According to INTERMACS data, overall survival in patients supported with implantable rotary blood pumps is approximately 80 % at 1 year and 70 % at 2 years. Current evidence suggests that rotary VAD support for prolonged duration is safe and effective. The incidence of complications (infection, stroke, bleeding, pump thrombosis, device failure) has decreased over the years. However, with longer time on support, many forms of interaction between the implanted device and the body have been recognized. The management of these interactions and complications during support remains challenging, but it is feasible, giving patients supported with a VAD the opportunity to return home and resume their normal lives.
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Acknowledgments
The authors thank Anne Gale, Editor in Life Sciences, for editorial assistance, and Ewald Hennig, PhD, and Friedrich Kaufmann, Dipl. Eng. for their technical support.
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Stepanenko, A., Potapov, E., Falk, V., Krabatsch, T. (2016). Mechanical Circulatory Support in End-Stage Heart Failure: Bridge to Transplantation and Destination Therapy. In: Leone, O., Angelini, A., Bruneval, P., Potena, L. (eds) The Pathology of Cardiac Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-46386-5_3
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DOI: https://doi.org/10.1007/978-3-319-46386-5_3
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