Author + information
- Received June 3, 2016
- Revision received March 23, 2017
- Accepted April 11, 2017
- Published online June 5, 2017.
- Sean P. Pinney, MDa,∗ (, )
- Anelechi C. Anyanwu, MDb,
- Anuradha Lala, MDa,
- Jeffrey J. Teuteberg, MDc,
- Nir Uriel, MDd and
- Mandeep R. Mehra, MDe
- aZena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- bDepartment of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
- cHeart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- dDepartment of Medicine, Cardiology Division, University of Chicago, Chicago, Illinois
- eDivision of Cardiology Heart and Vascular Center, Brigham and Women’s Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Sean P. Pinney, Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Continuous-flow left ventricular assist devices (LVADs) have revolutionized advanced heart failure care. These compact, fully implantable heart pumps are capable of providing meaningful increases in survival, functional capacity, and quality of life. Implantation volumes continue to grow, but several challenges remain to be overcome before LVADs will be considered as the therapy of choice for all patients with advanced heart failure. They must be able to consistently extend survival for the long term (7 to 10 years), rather than the midterm (3 to 5 years) more typical of contemporary devices; they must incorporate design elements that reduce shear stress and avoid stasis to reduce the frequent adverse events of bleeding, stroke, and pump thrombosis; and they must become more cost-effective. The advancements in engineering, implantation technique, and medical management detailed in this review will highlight the progress made toward achieving lifelong LVAD support and the challenges that remain.
Dr. Pinney has received consultant and speaker fees from CareDx, Inc. and Abbott, Inc. (previously St. Jude Medical, Inc.). Dr. Teuteberg has served on advisory boards for and received speaker fees from Medtronic, Inc. (formerly HeartWare), Abiomed, Inc., and CareDx, Inc.; and has served as a clinical events committee member for Abbott, Inc. (MOMENTUM 3). Dr. Uriel has served as a consultant for and received grant support from Abbott, Inc., Medtronic, Inc., and Novartis, Inc. Dr. Mehra has served on a clinical trial steering committee or data safety monitoring board or has performed clinical trial design consulting for Abbott, Inc., Medtronic, Stealth BioTherapeutics, Johnson and Johnson (Janssen), and Mesoblast, Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Danny Ramzy, MD, PhD, served as Guest Editor for this article.
- Received June 3, 2016.
- Revision received March 23, 2017.
- Accepted April 11, 2017.
- 2017 American College of Cardiology Foundation
- Central Illustration
- Optimizing Hemodynamics and Flow
- Overcoming the Challenge of Adverse Events
- Progress Toward Biocompatibility: MOMENTUM 3
- Innovative Surgical Approaches
- The Potential for Myocardial Recovery
- Shared Decision Making and Earlier Implantation
- Achieving Cost-Effectiveness
- Conclusions and the Future of the Field