How to Optimize Patient Selection and Device Performance of the Newest Generation Left Ventricular Assist Devices

摘要

Purpose of review This review will discuss key differences of third-generation left ventricular assist devices (LVADs), identify patient selection considerations to optimize post-implant clinical outcomes, and summarize key echocardiographic and hemodynamic parameters to guide device optimization. Recent findings There are major engineering differences between the third-generation LVADs which contribute to unique pump operational characteristics. Improved hemocompatibility has led to reduction in hemocompatibility-related adverse events (HRAEs), particularly for the Heartmate 3 pump. Having an optimal hemodynamic profile compared with not while on LVAD support defined by either echocardiography or right heart catheterization is associated with a more favorable event-free survival. Summary With attentive patient selection, use of current third-generation LVADs, and appropriate use of echocardiography and invasive ramp studies, LVAD therapy will continue to improve survival and quality of life in select patients with advanced heart failure.