Update on Mechanical Circulatory Support in Heart Failure
Update on Mechanical Circulatory Support in Heart Failure
LVADs have been shown to be efficacious as a bridge to transplantation and as destination therapy in advanced heart failure. The threshold level of heart failure beyond which patients will benefit from the insertion of an LVAD needs to be determined. Currently, LVADs are indicated in patients with advanced heart failure who cannot be weaned from inotropic support and who have a cardiac index <2.0 l/min/m, a systolic blood pressure <80 mm Hg, and a pulmonary capillary wedge pressure >20 mm Hg (Hunt 2001). As the technology improves and as LVADs get smaller, more efficient and safer, it is likely that this threshold level will change such that patients with less advanced heart failure may also benefit from an LVAD (Birks 2010).
Conclusion
LVADs have been shown to be efficacious as a bridge to transplantation and as destination therapy in advanced heart failure. The threshold level of heart failure beyond which patients will benefit from the insertion of an LVAD needs to be determined. Currently, LVADs are indicated in patients with advanced heart failure who cannot be weaned from inotropic support and who have a cardiac index <2.0 l/min/m, a systolic blood pressure <80 mm Hg, and a pulmonary capillary wedge pressure >20 mm Hg (Hunt 2001). As the technology improves and as LVADs get smaller, more efficient and safer, it is likely that this threshold level will change such that patients with less advanced heart failure may also benefit from an LVAD (Birks 2010).
