Balancing Bleeding and Clotting
The Known Unknowns of Mechanically Assisted Circulation
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Mechanically assisted circulation has established a firm footing in the management of patients with advanced heart failure. Relative to the high predicted mortality and poor quality of life associated with inotrope-dependent heart failure, clinical trials and registries have demonstrated a highly favorable impact of left ventricular assist devices (LVADs) on these important, patient-centric outcomes. More recently, LVADs were shown to improve survival and submaximal exercise performance in ambulatory heart failure patients not treated with inotropic support.1 Despite this growing and compelling literature, broader adoption by the heart failure and cardiovascular communities has been limited—an interesting paradox for one of the most impactful therapies ever developed to reduce cardiovascular mortality. Concerns over patient selection, device durability, postimplant quality and quantity of life, adverse events, therapeutic complexity, and cost likely fuel the uncertainty.
See Article by Andreas et al
Seventy percent of patients have a serious adverse event in the first year of LVAD therapy highlighting the need to refine the unique interplay between man, machine, and medicine required to achieve the potential of the therapy.2 Although some adverse events, such as driveline infections, are more directly attributable to human factors, others are linked to the interaction between blood components, the blood-contacting surfaces of the pump, shear stress, and the medications …