• Jan F Gummert, Axel Haverich, Jan D Schmitto, Evgenij Potapov, René Schramm, and Volkmar Falk.
• Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany; Department of Cardiovascular Surgery, Charité, Universitätsmedizin Berlin; German Center of Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung) - DZHK, Partner Site Berlin; Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; Department of Thoracic and Cardiovascular Surgery, German Heart Center, Berlin, Germany.
• Dtsch Arztebl Int. 2019 Dec 13; 116 (50): 843-848.

BackgroundNearly 1000 permanent ventricular assist devices (VADs) are implanted in patients with severe congestive heart failure in Germany each year. VADs are miniaturized centrifugal pumps that generate continuous blood flow; they are powered and controlled through a cable that passes through the skin. Para- corporeal systems are only rarely implanted, usually in children.MethodsIn this selective review of the literature, including guidelines and registry data, we discuss the indications, therapeutic effects, and complications of permanently implantable cardiac support systems.ResultsThe optimal time for VAD implantation cannot be precisely defined. A comparative assessment of the various available systems is not possible, as no randomized trials have been performed on this topic. Registry data indicate that 69% to 81% of patients survive one year after VAD implantation, which is signifi- cantly better than the natural course of (conservatively treated) severe congestive heart failure. The distance patients are able to walk is 129 to 220 m longer at six months, depending on the system implanted. Scores on the EQ-5D health status questionnaire are 28 to 37 points better at six months. The potential severe compli- cations include infection, right-heart failure, hemorrhage, pump thrombosis, stroke, and death.ConclusionA VAD system can be implanted as an alternative to cardiac transplan- tation or as a bridging treatment until the patient can be listed for transplantation and receive the transplant. Because of the organ s , only a minority of VAD patients ever receive a transplant.

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