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(Circulation. 1997;95:2340-2343.)
© 1997 American Heart Association, Inc.

Articles

Deep Thoughts on Tin Men

Fact, Fallacy, and Future of Mechanical Circulatory Support

Howard R. Levin, MD; Myron L. Weisfeldt, MD

Cardio Technologies, Inc (H.R.L.), and the Department of Medicine, Columbia-Presbyterian Medical Center (M.L.W.), New York, NY.

	Introduction

 
Since the first artificial heart implant in 1969, physicians have expressed both ardent enthusiasm and serious doubt regarding the potential of mechanical devices to replace the failing human heart.¹ The recent funding of the REMATCH trial by the US NIH may best illustrate the renewed interest in mechanical circulatory support. This trial is a milestone in the development of mechanical support because it will be the first large, controlled trial of the effect of LVAD support on survival when used as a permanent alternative to medical therapy.

In large part, the basis for this renewed optimism in mechanical circulatory support has been the impressive success of the LVAD in its "bridge-to-transplant" role of providing hemodynamic support until a donor heart is available.² A recent study showed that 72% of patients supported with a LVAD survived for 60 days after heart transplantation, compared with 33% of patients who received medical therapy alone.³ A more limited but still impressive experience with long-term LVAD therapy has been obtained among patients now successfully supported for 1 year; a handful of patients have been supported for almost 2 years. Furthermore, patients supported with LVADs are in general better transplant candidates, because they experience a significant improvement in vital organ function during support.⁴

In this issue of Circulation, Jaski et al⁵ report their experience with the improvements in exercise capacity that can be achieved with LVAD support. Their study illustrates the need for a better understanding of the underlying physiology of LVAD support before a . . . [Full Text of this Article]

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