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Transplant Versus VAD: Evolving and Future Perspectives

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Ventricular Assist Devices in Advanced-Stage Heart Failure

Abstract

Continuous-flow left ventricular assist devices (CF-LVADs) have become an essential therapeutic option in the standard of care for patients with end-stage heart failure. Clinical outcomes continue to improve through better patient selection, surgical technique, and perioperative management. Current two-year survival rates could exceed 80 % with device support in selected patients, and this is comparable to that of cardiac transplantation. As such, there has been a proliferation in the number of patients receiving device therapy and the centers implanting them. Moreover, CF-LVADs may also provide a platform for innovative treatments, including regenerative and stem cell therapies, to promote functional recovery of the native heart. These advantageous features should encourage the use of CF-LVADs as a replacement for cardiac transplantation in patients with stage D heart failure. However, as compared to transplant, quality of life and device-related costs may be limiting factors. In this relatively nascent field, more clinical trial data, especially from long-term follow-up, will be necessary to evaluate the risks and benefits of durable device support. Ultimately, a head-to-head comparison between the two therapies may need to be considered to answer the inevitable question: can CF-LVAD therapy replace cardiac transplantation as the preferred treatment for advanced heart disease? In the current era, however, it is far more important to appreciate how both strategies may be complementary and under what circumstances, one obviates the other, in order to achieve the best clinical outcome for the patient with end-stage heart failure.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Columbia University, 177 Fort Washington Ave, MHB 7-435, New York, NY, 10032, USA

    Hiroo Takayama & Yoshifumi Naka

  2. Division of Cardiology, Columbia University, 177 Fort Washington Ave, MHB 7-435, New York, NY, 10032, USA

    Sunu Thomas

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  1. Hiroo Takayama
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  2. Sunu Thomas
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  3. Yoshifumi Naka
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Correspondence to Yoshifumi Naka .

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Editors and Affiliations

  1. Dept. of The Therapeutic Strategy for Heart Failure, The University of Tokyo Hospital, Graduate School of Medicine, The University of Tokyo, Tokyo, Tokyo, Japan

    Shunei Kyo

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Takayama, H., Thomas, S., Naka, Y. (2014). Transplant Versus VAD: Evolving and Future Perspectives. In: Kyo, S. (eds) Ventricular Assist Devices in Advanced-Stage Heart Failure. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54466-1_6

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  • DOI: https://doi.org/10.1007/978-4-431-54466-1_6

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  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-54465-4

  • Online ISBN: 978-4-431-54466-1

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