Features  |   September 2015
Ventricular Assist Devices and Non-Cardiac Surgery in 2015
Author Affiliations
  • Sheela Pai Cole, M.D.
    Educational Track Subcommittee on Critical Care
Article Information
Cardiovascular Anesthesia / Technology / Equipment / Monitoring / Features
Features   |   September 2015
Ventricular Assist Devices and Non-Cardiac Surgery in 2015
ASA Monitor 09 2015, Vol.79, 22-25.
ASA Monitor 09 2015, Vol.79, 22-25.
The Centers for Disease Control and Prevention (CDC) estimate that about 5.1 million people in the United States experience heart failure, and heart failure remains a leading cause of death, with one in nine deaths in 2009 attributed to the diagnosis.1  Furthermore, 50 percent of people diagnosed with heart failure are dead within five years of diagnosis. Financially, the ramifications of heart failure remain steep, with an estimated $32 billion each year spent in health care services and medications to treat heart failure, and missed days of work due to the condition.2 
In 2001, the pivotal Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial demonstrated the superiority of VAD therapy with ventricular assist devices (VADs) when compared with medical therapy for heart failure.3  Initially, VADs were used as a therapy for patients awaiting heart transplant, as in bridge to transplantation (BTT); now, the indication has expanded to destination therapy (DT) to provide improved quality of life to patients who are not eligible for heart transplant. A relatively new indication for implantation is bridge to candidacy (BTC), whereby the patient is implanted with a VAD to assess suitability for heart transplantation. Patients in this group include those with severe pulmonary hypertension who would traditionally be considered for heart-lung transplantation but have shown reversal of pulmonary hypertension after VAD placement.4  Regardless of the indication for VAD placement, these devices have become standard of care for certain heart failure patients and are being implemented in several centers across the country. VADs can be implanted for a temporary or permanent duration, on left side only or, less frequently, on right-side alone, and in some circumstances on both sides in the form of bi-ventricular devices. VADs can further be classified into pulsatile (providing pulsatile flow to the end organs) or continuous flow devices that provide laminar, non-pulsatile flow to the end organs. The current technological advances in VAD mechanism favors use of non-pulsatile or continuous flow devices for long-term support regardless of the indication for which it was placed.
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