A review of clinical ventricular assist devices

Given the limited availability of donor hearts, ventricular assist device (VAD) therapy is fast becoming an accepted alternative treatment strategy to treat end-stage heart failure. The field of mechanical ventricular assistance is littered with novel and unique ideas either based on volume displacement or rotary pump technology, which aim to sufficiently restore cardiac output. However, only a select few have made the transition to the clinical arena. al implants were initially dominated by the FDA approved volume displacement Thoratec HeartMate I, IVAD, and PVAD, whilst Berlin Heartʹs EXCOR, and Abiomedʹs BVS5000 and AB5000 offered suitable alternatives. However, limitations associated with an inherently large size and reduced lifetime of these devices stimulated the development and subsequent implantation of rotary blood pump (RBP) technology. Almost all of the reviewed RBPs are clinically available in Europe, whilst many are still undergoing clinical trial in the USA. Thoratecʹs HeartMate II is currently the only rotary device approved by the FDA, and has supported the highest number of patients to date. This pump is joined by MicroMed Cardiovascularʹs Heart Assist 5 Adult VAD, Jarvik Heartʹs Jarvik 2000 FlowMaker and Berlin Heartʹs InCOR as the axial flow devices under investigation in the USA. More recently developed radial flow devices such as WorldHeartʹs Levacor, Terumoʹs DuraHeart, and HeartWareʹs HVAD are increasing in their clinical trial patient numbers. Finally CircuLiteʹs Synergy and Abiomedʹs Impella are two mixed flow type devices designed to offer partial cardiac support to less sick patients. eview provides a brief overview of the volume displacement and rotary devices which are either clinically available, or undergoing the advanced stages of human clinical trials.