Abstract
Heart failure is a major and growing public health issue. Recognition of its initial symptoms by general practitioners and cardiologists is crucial because of a very poor prognosis in later stages. Recent guidelines recommend an early referral to a multidisciplinary team of heart failure specialists. In earlier stages, pharmacological and non-surgical device treatments are established options to delay disease progression and help to control its symptoms. Surgical options then include myocardial revascularization, valvular reconstruction or replacement, LV-reconstruction and pericardectomy. Heart transplantation (HTx) is the standard treatment for end-stage disease refractory to medical therapy but is only possible for a minority of patients. Due to the shortage of donor organs and the impressive evolution of VAD systems and their implantation techniques, assist devices are increasingly evolving into an alternative to HTx. VADs can be used as a bridge to transplantation or recovery of the diseased heart or as a permanent support. For modern continuous-flow systems, minimally invasive implantation procedures are available and discharge to outpatient care is possible. Close attention should be paid to patient selection and planning of the optimal implantation time. For most of the patients a continuous-flow LVAD is an adequate support, in case of right heart failure additional use of a RVAD is possible. BVADs or the TAH are reserved for individual cases as a bridge to transplantation. During VAD treatment there is a need for anticoagulation and there are clinically relevant risks of bleeding and thrombo-embolic complications. Upcoming systems will be of even smaller size and are expected to be designed to be fully implantable, use wireless energy transfer and therefore will achieve a further minimization of complication rates and perioperative risks.
