Operating in the Dark

The benefits of left ventricular assist device (LVAD) therapy in advanced heart failure are clear—device implantation can prolong patient survival, enhance functionality, and improve quality of life. Since US Food and Drug Administration approval of the first continuous-flow LVAD in 2008, utilization has grown rapidly, and now, >2500 devices are placed annually. Given the current epidemic of heart failure, this volume may only be scratching the surface. Current estimates suggest that there are upwards of 250 000 to 300 000 potential LVAD candidates in the United States alone. Despite technological and design advances, broader application of LVAD therapy remains limited in part by its relatively high rate of adverse events (AEs). Six-month freedom from rehospitalization is only 40%, whereas 70% of patients will experience an AE within the first year of support.