Left ventricular assist devices: current status and future applications

Despite the advances in the medical management of heart failure over the last 20 years it remains a major cause of morbidity and mortality. While cardiac transplantation has evolved into an established mode of therapy, the number of patients with severe heart failure who could benefit from cardiac transplantation far exceeds the supply of donor organs [1]. The development of an implantable left ventricular assist device (LVAD) began in the early 1970s in centres such as the Texas Heart Institute and was funded by the National Heart, Lung, and Blood Institute. Clinical trials of these devices began in the mid 1980s [2] and several hundred patients have now been supported with one or other of these devices [3, 4]. Most patients have had an LVAD implanted as a bridge to cardiac transplantation. Recently there has also been interest in the use of an LVAD for (a) permanent ventricular support and (b) as a bridge to recovery in patients with potentially reversible causes of heart failure.