Are ventricular assist devices underutilized?

A dramatic shift in the durability and reliability of ventricular assist device (VAD) therapy is taking hold due to the newer generations of continuous flow VADs that are either in clinical trials or under consideration by the Food and Drug Administration (FDA) for commercial approval. To expand the pool of potential mechanical circulatory support (MCS) patients, device reliability will need to prove to be greatly enhanced over previous generations of VADs and functional capacity and quality of life will need to improve substantially over baseline. Improved patient selection should have the simultaneously beneficial effects of improving outcomes while expanding the MCS patient population. The critical factors determining the likelihood of expansion of the MCS field include, but are not limited to, improvements in technology and its reliability, training and education of all advanced heart failure caregivers, improving availability of MCS geographically, and a shift in patient selection to a population more likely to benefit from MCS therapy.