Ventricular Assist Devices (VADs) are increasingly recognised as a viable long term treatment option. Their use has become routine in the USA and some EU markets to "bridge" transplant patients until a donor heart becomes available plus they are also gaining increased acceptance as long term alternatives to transplantation.
Recent studies for continuous flow VADs have demonstrated very good symptomatic relief and survival with data that is constantly improving: in bridge to transplant patients, the most recent survival data shows 90-94% 6 month survival, 85-91% 1 year survival and 70% 2 year survival for VADs15 Jens Garbade, Hartmuth B. Bittner, Markus J. Barten, and Friedrich-Wilhelm Mohr: Current Trends in Implantable Left Ventricular Assist Devices. Cardiology Research and Practice, vol. 2011, Article ID 290561, 9 pages, 2011. doi:10.4061/2011/290561. This compares very favourably to 26% 1 year survival and 6% 2 year survival for medical management16 Fang JC: Rise of the machines – left ventricular assist devices as permanent therapy for advanced heart failure. N Engl J Med 2009; 361(23) 2282-2285. Many patients have lived for 5 years or more, with the world’s longest surviving VAD recipient currently at 8 years. A new study of VAD recipients over 70 shows this population, who are not eligible for transplantation, derives similar benefits to younger patients17 Adamson RM, Stahovich M, Chillcott S et al: Clinical Strategies and outcomes in advanced heart failure patients older than 70 years of age receiving the Heartmate II left ventricular assist device. J Am Coll Cardiol 2011 57 2487-2495.
Quality of life for VAD recipients is dramatically improved. Terminal advanced heart failure patients with severe symptoms at rest have recovered to NYHA functional class 1 or 2 with no symptoms at rest and moderate to good exercise tolerance18 Slaughter MS, Rogers JG, Milano CA et al: Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device. N Engl J Med. 2009;361:2241-2251. In everyday terms, this means that previously wheelchair-bound patients are able to cycle, take long walks, travel by air, drive vehicles and even go back to work within a few months of leaving hospital.
Although current outcomes for VADs are very promising, and certainly preferable to the alternative terminal prognosis with extremely poor quality of life, there are still issues with existing devices that limit their use. Primarily, existing devices are extremely expensive, making it difficult for healthcare systems to implant the numbers needed to fully meet the clinical demand. Also, existing devices are associated with significant complications, particularly thrombus formation19 Clarke, T. and D. Sherman (2011). HeartWare device had 9.2 percent thrombosis rate in trial. Reuters, with the potential for subsequent adverse medical events and these can lead to negative perceptions amongst cardiologists who care for heart failure patients. Additionally some devices are large, requiring surgery in both the chest and abdomen, which can hamper short term survival20 Lietz K, Long JW, Kfoury AG, et al: Outcomes of left ventricular assist device implantation as destination therapy.
Calon’s MiniVAD™ is being developed specifically to address these problems and to enable far more widespread adoption of VAD therapy.
Disclaimer: Calon Cardio’s VAD devices are not available for sale, including in the United States of America