Left Ventricular Assist Device (LVAD)

Thesis Statement

LVADs (Left Ventricular Assist Device); do we need to explore a new direction?

Introduction

There has been considerable amount of attention given to the use of the LVAD in research and thus far has proven its effectiveness, both in supporting patients who would not otherwise have survived to wait for a heart to become available, and in improving the survival post-transplant. There is still, however, debate as to the ideal time in the course of heart failure that would be most beneficial to use these devices in order to optimize outcomes (Felker and Benza et al. 997).

The number of patients diagnosed with heart failure has risen substantially in recent years, with subsequent rise in those patients qualifying for heart transplant. Currently, there are nearly 550,00 new cases of heart failure diagnosed each year, and approximately only 2,400 transplants occur each year in the United States with upwards of 4,000 patients on the waiting list to receive a heart.' (Felker and Benza et al. 997) It is also estimated that 50,000 of the previously mentioned patients could benefit from transplantation but because of limited donor availability, transplant would not be an option.' This raises a dilemma as to how to best manage this growing population until the time that they can be transplanted (Felker and Benza et al. 997). The use of inotropic medications has been a well-recognized therapy for patients in end stage heart failure awaiting transplantation; however the advancing technology of left ventricular assist devices is introducing an appealing alternative to current management (Felker and Benza et al. 997).

Discussion

Currently, it is not known whether utilizing these devices in the sickest patients can give the greatest survival benefit that an LV AD could potentially provide, and it remains unproven whether using these devices with less severe heart failure can surpass the outcomes achievable with optimal medical management.

Studies Regarding LVAD

Preliminary studies thus far have evaluated the effectiveness of mechanical assist as compared to optimal medical management and compared outcomes measured by survival analysis, mortality, and quality of life after randomization (Leitz and Long et al. 497). The REMATCH trial in 2004 had results that showed the use of LVAD implantation for patients who where refractory to medical management had a major survival benefit and improvement of quality of life. However, the patient population in this trial is historically still considered the sickest heart failure patients ever studied and still the survival benefit with the LVAD doubled the one year survival as compared to the medical management arm of the trial (Leitz and Long et al. 497). This trial was the first to demonstrate that utilization of the LVAD would provide support that was superior to any known medical treatment for patients that have severe heart failure and are not eligible for cardiac transplantation, and was identified as a precursor to further studies to be done when the technology for mechanical circulatory support further evolves (Leitz and Long et al. 497).

The follow up study ...