Left ventricular assist devices and bridge to transplant: Implanting earlier in the course of heart failure to improve outcomes.

摘要

Problem: The number of patients diagnosed with heart failure has markedly increased in recent years, resulting in a higher demand for cardiac transplantation, and a need for therapeutic options to maintain these patients before transplant. The use of inotropic medications has been a well-recognized therapy choice, but the use of ventricular assist devices has also become more popular, and continues to be studied as an appropriate, if not superior alternative. Methods: A search of Pub Med and Medline was utilized to search for articles covering the use of ventricular assist devices compared to use of inotropic therapy, also including articles that covered each topic individually, within the last 10 years. Key words were used such as "inotropes and heart failure", "inotropes and bridge to transplant", "VAD's and bridge to transplant" and "VAD's and heart failure" for search terms. Articles were then retrieved and searched from the reference lists of those articles to find other potentially relevant articles. Results: Prognosis was compared by measuring hemodynamics, creatinine changes during therapy, 5-year survival, post-transplant infection, as well as acute and chronic rejection. The major findings in the studies were that survival rates were either equal or improved with the use of ventricular assist devices. Conclusion: There is a clear survival benefit of the use of LVADs as compared to optimal medical management only, and there was an identified need for future studies to analyze how disease severity, patient selection and timing of implantation can influence outcomes of the use of mechanical circulatory support.