JMSA JOURNAL VOL. 5 NO. 1
Japanese Medical Society of America
M. Adachi, M.D., Sc.D. and J. Furuyama, D.D.S. (Editors)
Heart Transplantation, Artificial Heart, and Device Lag
Hiroo Takayama, M.D., Ph.D., Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center
Heart failure (HF) remains one of the most common causes of death in the United States. The 2005 ACC/AHA guidelines introduced a comprehensive and systematic method of assessing and managing patients with risk factors and those with HF. The suggested staging system is ambitiously inclusive, covering a wide range of patients with cardiovascular problems. It categorizes patients into Stages A (at high risk for HF but without structural heart disease or symptoms of HF) to D (refractory HF requiring specialized interventions). Medical treatment is extremely limited for HF patients in Stage D. Among the available surgical interventions for HF, left ventricular assist device (LVAD) is distinct from the others in that it, at least partially, replaces the pump function of the failing heart, similar to heart transplantation. Unlike heart transplantation, however, it does not rely on a human donor supply, which is a well-known limiting factor. As technological advances have accrued, LVAD has evolved into a reliable and well-described treatment option.