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Review
. 2023 Apr 21;13(4):1065.
doi: 10.3390/life13041065.

Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection

María Melendo-Viu  1   2   3 , David Dobarro  1   2 , Sergio Raposeiras Roubin  1   2 , Carmen Llamas Pernas  4 , Candela Moliz Cordón  5 , Miriam Vazquez Lamas  4 , Miguel Piñón Esteban  6 , Maria Ángela Varela Martínez  4 , Emad Abu Assi  1   2 , Rafael Pita Romero  4 , Juan José Legarra Calderón  6 , Andrés Íñiguez Romo  1   2
Affiliations
Review

Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection

María Melendo-Viu et al. Life (Basel). .

Abstract

Advanced heart failure is a growing problem for which the best treatment is cardiac transplantation. However, the shortage of donors' hearts made left ventricular assist devices as destination therapy (DT-LVAD) a highly recommended alternative: they improved mid-term prognosis as well as patients' quality of life. Current intracorporeal pumps with a centrifugal continuous flow evolved in the last few years. Since 2003, when first LVAD was approved for long-term support, smaller device sizes with better survival and hemocompatibility profile were reached. The most important difficulty lies in the moment of the implant. Recent indications range from INTERMACS class 2 to 4, with close monitoring in intermediate cases. Moreover, a large multiparametric study is needed for considering the candidacy: basal situation, with a special interest in frailty, comorbidities, including renal and hepatic dysfunction, and medical background, considering every prior cardiac condition, must be evaluated. In addition, some clinical risk scores can be helpful to measure the possibility of right heart failure or morbi-mortality. With this review, we sought to summarize all the device improvements, with their updated clinical results, as well as to focus on all the patient selection criteria.

Keywords: comorbidities; destination therapy; frailty; left ventricular assist device; patient selection; right ventricular disfunction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Main components of every LVAD, (B) timeline of LVAD pivotal trials.
Figure 2
Figure 2
Multidisciplinary team involved in LVAD care.
Figure 3
Figure 3
Patient selection checklist for DT-LVAD candidacy.
See this image and copyright information in PMC

References

    1. Roger V.L. Epidemiology of Heart Failure. Circ. Res. 2021;128:1421–1434. doi: 10.1161/CIRCRESAHA.121.318172. - DOI - PubMed
    1. Conrad N., Judge A., Canoy D., Tran J., Pinho-Gomes A.-C., Millett E.R.C., Salimi-Khorshidi G., Cleland J.G., McMurray J.J.V., Rahimi K. Temporal Trends and Patterns in Mortality after Incident Heart Failure: A Longitudinal Analysis of 86,000 Individuals. JAMA Cardiol. 2019;4:1102–1111. doi: 10.1001/jamacardio.2019.3593. - DOI - PMC - PubMed
    1. Schmidt M., Ulrichsen S.P., Pedersen L., Bøtker H.E., Sørensen H.T. Thirty-year trends in heart failure hospitalization and mortality rates and the prognostic impact of co-morbidity: A Danish nationwide cohort study. Eur. J. Heart Fail. 2016;18:490–499. doi: 10.1002/ejhf.486. - DOI - PubMed
    1. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., Burri H., Butler J., Čelutkienė J., Chioncel O., et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2021;42:3599–3726. doi: 10.1093/eurheartj/ehab368. - DOI - PubMed
    1. Khush K.K., Hsich E., Potena L., Cherikh W.S., Chambers D.C., Harhay M.O., Hayes D., Perch M., Sadavarte A., Toll A., et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult heart transplantation report—2021; Focus on recipient characteristics. J. Heart Lung Transplant. 2021;40:1035–1049. doi: 10.1016/j.healun.2021.07.015. - DOI - PMC - PubMed

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