ABSTRACT
Improvements in the prevention and treatment of cardiovascular disease in young and
middle-aged adults has extended the average life expectancy, resulting in a steadily
increasing number of people with chronic cardiovascular disease. A large proportion of this
population consists of individuals suffering from chronic congestive heart failure. In the
United States, nearly five million persons suffer from heart failure, with almost 500,000 new
patients diagnosed each year. While many of these patients achieve a reasonable quality of
life with judicious medical management, a substantial segment experience severe
congestive symptoms and profound debilitation that goes well beyond what current
medical therapies can treat. A tiny fraction of these end-stage patients, about 3000 patients
per year, undergo cardiac transplantation, relegating hundreds of thousands of heart failure
patients to repeated inpatient admissions and death within several years of diagnosis. The
perennial dearth of cardiac donors has driven the successful development of mechanical
assist devices as a bridge to transplantation, however this strategy is limited to a selected
group of patients who fit stringent cardiac transplant criteria. Most recently, “destination
therapy” for medically-refractory heart failure patients who would not otherwise qualify
for cardiac transplantation has been validated by the landmark REMATCH trial (1).
However, although the quality of life among these patients was significantly improved with
left ventricular assist devices (LVAD), long-term survival was quite limited by
complications, with only 23% of LVAD patients surviving up to two years (2). The advent
of newer generation LVADs brings modest promise of longer-term survival, however this
has yet to be fully evaluated with multicenter trials. Furthermore, the relatively high health
care costs associated with LVADs currently limits their broad short-and long-term use as a
standard heart failure therapy.
