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

摘要

At 40 years of age, the lifetime risk of developing heart failure (HF) is 1 in 5 for men and women in the United States. Approximately half of patients who are ultimately diagnosed with HF will die within 5 years; the associated morbidity, hospitalization rate, and loss of functional capacity are more difficult to calculate. Among the 5 million American patients currently living with HF, it is estimated that 200 000 patients have American College of Cardiology/American Heart Association stage D or refractory HF, resulting in markedly diminished functional status and survival. In 2012, 2 therapies are available to potentially prolong survival and to improve quality of life for end-stage HF patients: heart transplantation and long-term mechanical circulatory support in the form of a ventricular assist device (VAD). For permanent mechanical support, also referred to as destination therapy (DT), the Food and Drug Administration approved the use of the HeartMate II (Thoratec Corp, Pleasanton, CA) left ventricular assist device (LVAD) in January 2010. This device supports only the left ventricle; no biventricular device is approved for long-term therapy at this time.