Muristek
Patients with heart failure can progress to develop advanced heart failure, a condition in which symptoms limit daily activities, recurrent hospitalizations for acute decompensated heart failure often occur, guideline-directed medical therapy is not tolerated, and survival is severely compromised. Durable left ventricular assist devices (LVADs) provide a therapeutic option for these patients in the setting of a reduced left ventricular ejection fraction. One such example is the HeartMate platform, which has evolved over a span of approximately 3 decades. Serial improvements in the design with each generation led to improved patient outcomes, as demonstrated in randomized trials in which the newer LVAD was compared with its predecessor. A first-generation LVAD in this platform (HeartMate XVE) was pulsatile, bulky, and predisposed to mechanical failure within 2 years, but it improved survival compared with optimal medical therapy in patients with advanced heart failure with reduced ejection fraction (HFrEF), especially those dependent on chronic intravenous infusions of inotropic agents. The second generation LVAD (HeartMate II) was a smaller rotary pump that generated flow along the axis of its rotor (axial-flow) and significantly improved outcomes when compared with the first-generation LVAD. However, the axial-flow LVAD was predisposed to LVAD thrombosis.
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