The use of durable mechanical circulatory support, such as a durable left ventricular assist device (dLVAD), is an important but often underutilized treatment for patients with advanced heart failure (HF), according to a JACC Scientific Statement published Sept. 25 in JACC.

Ryan J. Tedford, MD, FACC, et al., write that, with innovations in dLVAD technology, the risk of several adverse events has been reduced, such as pump thrombosis, stroke and bleeding. The “average patient survival is now similar to that of heart transplantation at two years, with five-year dLVAD survival now approaching 60%.” However, “greater adoption of dLVAD therapy has not been realized due to delayed referral of patients to advanced HF centers, insufficient clinician knowledge of contemporary dLVAD outcomes (including gains in quality of life), and deprioritization of patients with dLVAD support waiting for heart transplantation.”

In the Scientific Statement, the authors review contemporary outcomes with dLVADs, including patient-reported outcomes; current indications and timing of referral; patient selection; surgical considerations; unique patient populations, including women, children, and adults with congenital heart disease; and gaps in knowledge and future directions.

They note that several novel, durable mechanical circulatory support devices are on the way that would allow for less invasive surgical implantation and eliminate the percutaneous lead for power supply. They also acknowledge there are gaps that need to be addressed, including the need to “improve MCS use as a complement or alternative therapy to heart transplantation.”

Lastly, they state that dLVAD therapy can improve the survival and quality of life of patients with HF and that “if implemented and expedited, these developments can duplicate the significant progress achieved in the field.”