To build a better VAD: What is needed to make MCS truly competitive with cardiac transplantation for long-term outcomes?

Abstract

While average survival in patients undergoing durable left ventricular assist device (dLVAD) support now approximate 6 years, the application of therapy remains limited across the globe. Herein we highlight important deficiencies common to present technology and propose device innovations and field corrections that will be necessary to improve acceptance of dLVAD support by both patients and medical providers caring for patients with end-stage heart failure. Pragmatic trials will also be needed to help identify the therapeutic strategy (permanent dLVAD support vs heart transplant vs dLVAD as a bridge to transplant) that affords the best outcomes for a patient's risk profile and total survival goals.

Keywords: Adverse events; Heart failure; Heart transplant; LVAD; Outcomes; Survival.

Figure 1

Heart transplant volumes across the globe in the year 2023. Heart transplant volumes for 2023 are presented for countries providing data to the global observatory on donation and transplantation. The inset shows the rate of heart of transplant, adjusted per million people. Data available at: www.transplant-observatory.org.

Figure 2

Durable mechanical circulatory support volume (2019-2023). Annual implant volumes of durable mechanical circulatory support devices (MCS) are presented for the United States (US), Germany, UK (United Kingdom), and Spain for years 2019 to 2023. Volumes have not increased despite improvement in contemporary durable left ventricular assist technology and associated patient outcomes.

Figure 3

Considerations for patients and clinicians when comparing heart transplant with durable left ventricular assist device support for management of end-stage heart failure. Abbreviations: GI, gastrointestinal; LVAD, left ventricular assist device; RHF, right heart failure, VT, ventricular tachycardia.