Cardiology clinics
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The recent, widespread success of mechanical circulatory support has prompted the development of numerous implantable devices to treat advanced heart failure. It is important to raise awareness of novel device systems, the mechanisms by which they function, and implications for patient management. ⋯ Implantation strategy, mechanism of action, durability, efficacy, hemocompatibility, and human factors are considered. The feasibility of novel strategies for unloading the failing heart is examined.
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Nonreversible failure of the right ventricle is seen in 0.04% to 0.1% of postcardiotomy cases. The incidence of right ventricular dysfunction after left ventricular assist device (LVAD) implantation that fails to resolve in the operating room is reported to be as frequent as 20% to 50% and imposes a considerable burden in terms of postoperative morbidity and mortality. Should this syndrome supervene, the mortality of an LVAD operation increases from 19% to 43%. Although most patients can be maintained with prolonged inotropic support, 10% to 15% may require implantation of a separate right ventricular support device.