To build a better VAD: What is needed to make MCS truly competitive with cardiac transplantation for long-term outcomes?

Abstract

While average survival in patients undergoing durable left ventricular assist device (dLVAD) support now approximate 6 years, the application of therapy remains limited across the globe. Herein we highlight important deficiencies common to present technology and propose device innovations and field corrections that will be necessary to improve acceptance of dLVAD support by both patients and medical providers caring for patients with end-stage heart failure. Pragmatic trials will also be needed to help identify the therapeutic strategy (permanent dLVAD support vs heart transplant vs dLVAD as a bridge to transplant) that affords the best outcomes for a patient’s risk profile and total survival goals.