Mechanical circulatory support devices in the treatment of heart failure

With an increasingly aging population, heart failure is a major health issu e, affecting more than 10% of the population over 65 years of age, and cost ing hundreds of millions of dollars per year for ongoing care. Even with ma ximal medical therapy, annual mortality rates of in excess of 25% are commo nly reported. Over the last three decades, various surgical approaches have been examined in the hope of improving the outcome of congestive cardiac f ailure. These procedures range from simple coronary revascularisation to le ft ventricular reduction surgery and cardiac transplantation. Although of v alue in selected situations, no surgical approach, beyond transplantation, has had significant impact on the outcome of heart failure. In the last decade, development in the area of mechanical support for the f ailing heart has continued to expand at a rapid rate. Strong evidence now e xists to show that in many patients with advanced heart failure, prolonged mechanical support results in significant myocardial recovery. There are cu rrently several mechanical support devices available for clinical use, alth ough most are considered experimental in this country. These devices are ex pensive and are not without significant complications, but early results of their use as either a bridge to transplantation or as a stand alone treatm ent, have been very encouraging. Currently available mechanical assist devi ces are described, with discussion of indications for implantation, complic ations and results of their use.