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• W3086986209 abstract "Central MessageAdvances in LVAD therapy encompass all aspects of care: devices, management, and patient factors. Newer devices, improved techniques, and technological innovations will further drive this trend.See Article page 605.Especially in technology, we need revolutionary change, not incremental change.—Larry Page Advances in LVAD therapy encompass all aspects of care: devices, management, and patient factors. Newer devices, improved techniques, and technological innovations will further drive this trend. See Article page 605. Shaffer and colleagues1Shaffer A. Cogswell R. John R. Future developments in left ventricular assist device therapy.J Thorac Cardiovasc Surg. 2021; 162: 605-611Abstract Full Text Full Text PDF Scopus (3) Google Scholar review recent progress in durable left ventricular assist device (LVAD) devices and outline the current challenges to moving the technology forward. In this timely article, Shaffer and colleagues1Shaffer A. Cogswell R. John R. Future developments in left ventricular assist device therapy.J Thorac Cardiovasc Surg. 2021; 162: 605-611Abstract Full Text Full Text PDF Scopus (3) Google Scholar summarize the current benchmarks from published clinical trials, present the growing evidence supporting innovative surgical techniques, and identify nearing device innovations in LVAD therapy. The review encapsulates the advances that have occurred in all aspects of LVAD therapy—pump technology, patient factors, and management—in addition to reviewing the evidence for the currently available continuous flow LVADs, setting the context for the next phase of developments. Advances aimed at the intersection of pump technology, physician management, and patient factors have driven the field of mechanical circulatory support forward, not solely pump technology. The large number of physicians arguing the merits of better pumps versus better patients at professional meetings every year underscore this point. Advances are occurring every day, slowly moving the field forward; new pumps arrive about once a decade. The authors outline these incremental changes in all domains of mechanical circulatory support. Better pumps? The HM3 (Abbott, Chicago, Ill) has reported the lowest complication rates in a published clinical trial with 2-year survival nearing 83%.2Mehra M.R. Uriel N. Naka Y. Cleveland Jr., J.C. Yuzefpolskaya M. Salerno C.T. et al.A fully magnetically levitated left ventricular assist device—the final cohort.N Engl J Med. 2019; 380: 1618-1627Crossref PubMed Scopus (348) Google Scholar At the same time, the LATERAL trial using HVAD (Medtronic, Minneapolis, Minn) via a thoracotomy approach in a nonrandomized population achieved 87% 2-year survival.3McGee Jr., E. Danter M. Strueber M. Mahr C. Mokadam N.A. Wieselthaler G. et al.Evaluation of a lateral thoracotomy implant approach for a centrifugal-flow left ventricular assist device: the LATERAL clinical trial.J Heart Lung Transplant. 2019; 38: 344-351Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar Overall real-world 2-year survival from the 2019 Interagency Registry for Mechanically Assisted Circulatory Support report was lower than both at 73%.4Teuteberg J.J. Cleveland Jr., J.C. Cowger J. Higgins R.S. Goldstein D.J. Keebler M. et al.The Society of Thoracic Surgeons INTERMACS 2019 annual report: the changing landscape of devices and indications.Ann Thorac Surg. 2020; 109: 649-660Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar Such progress reflects not only advances in pump technology but also management and surgical technique. Better physicians? Surgeons need to pay attention: Like prior minimally invasive innovations in cardiac surgery, the data suggest benefits to less-invasive LVAD implantation and possibly off-pump implantation in select patients. Patient survival using these techniques with the currently available pumps are achieving exceptional survival rates for longer durations. These developments are also accruing economic benefits. With the advances in pumps, techniques, and management, patients have fewer complications and longer survival. This is driving down the cost of LVAD therapy significantly with measures now approaching or meeting current definitions of cost-effectiveness.5Silvestry S.C. Mahr C. Slaughter M. Levy W.C. Cheng R.K. May D.M. et al.Cost-effectiveness of a small intrapericardial centrifugal left ventricular assist device.ASAIO J. 2020; 66: 862-870Crossref PubMed Scopus (5) Google Scholar,6Mehra M.R. Salerno C. Cleveland J.C. Pinney S. Yuzefpolskaya M. Milano C.A. et al.Healthcare resource use and cost implications in the MOMENTUM 3 long-term outcome study: randomized controlled trial of a magnetically levitated cardiac pump in advanced heart failure.Circulation. 2018; 138: 1923-1934Crossref PubMed Scopus (31) Google Scholar Advances in policy reflect these clinical advances as well. United Network for Organ Sharing heart allocation now reflects the improved survival on the waitlist for LVAD patients and the Centers for Medicare and Medicaid Services plans to remove the distinction between the indications of destination therapy and bridge to transplant. The current platform of mechanical circulatory support is maturing in all aspects of the field. With totally implantable LVADs around the corner, we may be on the precipice of revolutionary change. With current pumps approaching transplant-level survival, and total implantable systems poised to enter clinical trials, is now the time for a clinical trial comparing LVAD and heart transplantation? Future developments in left ventricular assist device therapyThe Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 2PreviewFeature Editor's Introduction—Durable left ventricular assist device (LVAD) therapy has had a remarkable evolution over the past 2 decades. Moving from a therapy once confined to only bridge to transplant application with large pulsatile pumps, LVAD therapy now experiences widespread dissemination and adoption for patients with advanced heart failure, irrespective of heart transplant eligibility, utilizing miniature continuous flow centrifugal pumps with total magnetic levitation. Technological enhancements in pump design has been the major driving force for improved patient outcomes, but refinement of surgical techniques and patient management have made substantial contributions to current patient longevity on LVAD support. Full-Text PDF" @default.
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• W3086986209 title "Commentary: Better pumps, better patients, better physicians? Future developments in left ventricular assist device therapy" @default.
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