End-stage congestive heart failure: Ventricular assist devices

Approximately 5 million Americans have congestive heart failure (CHF), and every year about 50,000 new cases are diagnosed. Advances in medical therapy, biventricular pacing, defibrillator implantation, and the ability to successfully perform surgery in high-risk patients have revolutionized the management of patients with CHF and greatly delayed CHF progression to end stage. Once patients develop end-stage CHF, treatment options are limited and typically ineffective, and the mortality is high. Heart transplant thus becomes the last resort for end-stage CHF patients. Ventricular assist devices (VAD), especially left ventricular assist devices (LVAD), have been increasingly used to support such ill patients as a bridge-to-transplant therapy in the last decade. More recently, these devices have been used as a destination therapy for end-stage CHF as well. A newer generation of VADs with better mechanics, smaller size, and longer durability has been developed in recent years.