Should left ventricular assist device should be standard of care for patients with refractory heart failure who are not transplantation candidates?: Left ventricular assist devices should be considered standard of care for patients with refractory heart failure who are not transplantation candidates

摘要

The development of current mechanical circulatory support (MCS) systems began in the 1960s as an effort to provide a therapeutic option for patients with refractory advanced heart failure. Today, MCS represents a viable alternative to cardiac transplantation for the overwhelming majority of patients in whom age, comorbidities, or the profound shortage of donors makes transplantation infeasible. Painstaking work on the technique of orthotopic cardiac transplantation, coupled with advances in the knowledge of immunology, resulted in the improvements in survival and quality of life that make cardiac transplantation the treatment of choice for individuals with advanced heart failure. MCS has only recently become accepted for widespread clinical use.2Early MCS designs were based on the assumption that maintaining pulsatility of flow was a physiological necessity. These bulky devices were of limited durability and resulted in a great deal of morbidity in the form of hematologic, neurological, and infectious complications.