PMC:6537946 / 13714-16433 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6537946","sourcedb":"PMC","sourceid":"6537946","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6537946","text":"LIMITATIONS OF PERMANENT DEVICE SUPPORT\nIndependent of MCS flow-type, size and durability have improved over the years. Published data continue to reveal clear mid- and long-term survival benefits and superiority over optimal medical treatment in patients with end-stage heart failure [37]. However, the efficacy of VADs is limited in the long-term due to device-typical complications, resulting in a gradual drop in the survival rate (Fig. 2). A postapproval HeartMate II lifetime therapy report revealed a high probability of device-related adverse events in patients at the 2-year follow-up: driveline infections (19%), sepsis (19%), strokes (11.7%), thrombus formation (3.6%), bleeding (54%), mechanical failures requiring replacement (4%) and right heart failure (18%) [36]. Recent data from the Momentum-3 (Multicentre Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3) trial shows improvement of outcome parameters with the use of the HeartMate III device [13]. However, this trend needs to be supported by large-scale trials or registry data.\nFigure 2: Parametric survival curve and associated hazard function with 70% confidence limit for survival after implantation of a continuous-flow LVAD or BiVAD. Reprinted with permission from Ref. [12]. BiVAD: biventricular assist device; LVAD: left ventricular assist device. The QoL of patients with MCS is far from optimal: The VAD can alleviate some heart failure symptoms, improve impaired end-organ function and raise the patient’s QoL somewhat. Nevertheless, several functional limitations persist: patients still lack independence, and MCS-related complications also significantly affect QoL. Psychological distress remains a serious problem after LVAD implantation [38]. In contrast, patients who have had a heart transplant had the best outcome compared with the LVAD group in terms of their mental health [39].\nIt remains unclear whether mechanical support affects the prognosis after a heart transplant: Some evidence shows that the post-heart transplant prognosis is impaired due to donor-specific antibodies triggering rejection and contributing to morbidity and mortality after the operation [8]. Moreover, recent evidence indicates that pretransplant MCS is a risk factor for primary graft failure [40]. Regarding the rising number of MCS recipients over the last few years, this fact will certainly affect transplant medicine in the future: In 2000, the International Society for Heart and Lung Transplantation reported that 19.1% of transplant recipients had been on mechanical support previously, a percentage that rose to 43.9% in the current transplant collective from 2009 to 2017 [8, 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