Page 410 - fbkCardioDiabetes_2017

386 Mechanical Circulatory Support for
Advanced Heart Failure

Future directions:

• Design of hemocompatible surfaces will alleviate the need for anticoagulation and
minimize the risk of bleeding, pump thrombosis and stroke.
• Modulation of pulsatility in newer ventricular assist devices will likely decrease the
complications related to gastrointestinal bleeding or aortic valve insufficiency.
• Pump speed modulation will be used for antithrombotic cycling to prevent pump
thrombosis.
• In the future, speed modulation algorithms will respond to specific physiological
demands, such as those related to exercise and remote monitoring will be able to
control the pump.
• The advent of transcutaneous energy transfer will allow the development of
completely implantable devices, with improved quality of life and marked decrease
in the risk for infections.
• Newer devices will be miniaturized and will allow for smaller surgical or
transcatheter implantation.
• Similarly to cardiac implantable electric devices, remote monitoring will allow for
real time assessment of pump function.
• Ventricular assist devices will be used as platforms allowing concomitant
administration of full dose neurohormonal blockade and intramyocardial injections
of stem cells that will lead to myocardial recovery.

References:
1. Mozaffarian D, Benjamin EJ, Go AS, et al.; American Heart Association
Statistics Committee and Stroke Statistics Subcommittee. Executive Sum-
mary: Heart Disease and Stroke Statistics - 2016 Update: A Report From
the American Heart Association. Circulation. 2016; 133: 447-454.
2. Mehra MR, Canter CE, Hannan MM, et al. The 2016 International Society
for Heart Lung Transplantation listing criteria for heart transplantation: A
10-year update. J Heart Lung Transplant. 2016; 35: 1-23.
3. Fang JC, Ewald GA, Allen LA, et al. Advanced (stage D) heart failure: a
statement from the Heart Failure Society of America Guidelines commit-
tee. J Cardiac Fail. 2015; 21: 519-534.
4. Stevenson LW, Pagani FD, Young JB, et al. INTERMACS profiles of ad-
vanced heart failure: the current picture. J Heart Lung Transplant. 2009;
28: 535-541.
5. Kirklin JK, Naftel DC, Pagani FD, et al. Seventh INTERMACS annual re-
port: 15,000 patients and counting. J Heart Lung Transplant. 2015; 34:
1495-1504.
6. Estep JD, Starling RC, Horstmanshof DA, et al. Risk assessment and
comparative effectiveness of left ventricular assist device and medical man-
agement in ambulatory heart failure patients: results from the ROADMAP
study. J Am CollCardiol. 2015; 66: 1747-1761.

GCDC 2017