Durable Mechanical Circulatory Support: JACC Scientific Statement (JACC October 2023-1)-Article: Durable Mechanical Circulatory Support: JACC Scientific Statement

Article: Durable Mechanical Circulatory Support: JACC Scientific Statement

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The JACC Scientific Statement on Durable Mechanical Circulatory Support highlights the advancements and challenges in the treatment of advanced heart failure (HF) using durable left ventricular assist devices (dLVADs). Despite advancements in medical therapies, the survival rate for patients with advanced HF remains low, with a 5-year survival rate of approximately 20%. dLVADs have become a vital treatment option, significantly improving survival rates to nearly 60% at the 5-year mark.<br /><br />Early models of mechanical circulatory support (MCS) focused on total artificial hearts but shifted towards more practical LVADs, which provide univentricular support. These devices have evolved from pulsatile to continuous-flow rotary pumps, resulting in improved durability and reduced adverse events, such as pump thrombosis, stroke, and bleeding.<br /><br />Despite these advancements, the adoption of dLVADs has been hampered by issues such as delayed referrals, insufficient clinician knowledge, and changes in donor heart allocation policies. The survival rate for patients with contemporary LVADs has markedly improved, with the HeartMate 3 leading to 87% one-year survival rates. However, adverse events, including hospital readmissions, remain significant, with only about 30% of patients free from readmission within a year of implantation.<br /><br />There have also been substantial improvements in patients' health-related quality of life (HRQOL) and functional capacity post-implantation. The HeartMate 3, in particular, has shown significant gains in these areas without compromising survival even in the presence of adverse events.<br /><br />Recent policy changes have affected the usage patterns of durable MCS as a bridge to transplant (BTT) versus destination therapy (DT). Innovations in LVAD technology continue, with new devices on the horizon aiming for smaller sizes, less invasive implantation techniques, and elimination of percutaneous leads.<br /><br />Gaps remain in educating both healthcare providers and patients about the benefits and contemporary outcomes of durable MCS. Future goals include further reducing adverse event rates, enhancing device technology, and improving overall patient outcomes to expand the use of these life-saving devices.

Keywords

Durable Mechanical Circulatory Support

Advanced Heart Failure

Left Ventricular Assist Devices

dLVADs

HeartMate 3

Survival Rates

Adverse Events

Health-Related Quality of Life

Destination Therapy

Bridge to Transplant