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Ann Thorac Surg 2001;71:S86-S91
© 2001 The Society of Thoracic Surgeons

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Session 2: bridging to transplant and alternatives to transplant

Indications and patient selection for mechanical ventricular assistance

^a Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA

Address reprint requests to Dr Oz, MHB 7-435, 177 Ft. Washington Ave, New York, NY 10032
e-mail: mco2{at}columbia.edu

Presented at the Fifth International Conference on Circulatory Support Devices for Severe Cardiac Failure, New York, NY, Sept 15–17, 2000.

Abstract

Cardiac assist devices have become an important component of transplantation programs as they successfully bridge unsalvageable patients who would otherwise die. The indications for a device can still be classified into short-term and long-term situations. The short-term indications have expanded into areas such as postcardiotomy failure, high-risk cardiac operations, and acute myocardial infarction with results that were not previously possible in the absence of a well-established mechanical assistance program. Appropriate patient selection remains challenging and perhaps the most important attribute of a successful ventricular assist program. Although few exact criteria can define patients who are not eligible, several considerations and screening scales can help determine a particular patient’s suitability. Specific attention must be given to right heart function, neurologic status, existing infections, renal function, and transplantation suitability. The future of this field will not only be in technological advances with devices but in optimization of patient selection and expanding indications such as permanent replacement therapy.