Ventricular Assist Devices As Destination Therapy In Advanced Chronic Heart Failure

Epidemiological data reveals an increase in the prevalence of the congestive heart failure in our country, currently 6,8% and an annual incidence of 1% in patients older than 65 years. The mortality of this pathology reaches 50% at 5 years even with appropriate medical treatment. Although important developments have been observed in the treatment through pharmacological neurohormonal blockade, it seems it has reached the limit of its possibilities in many patients. From a surgical point of view, surgical reshaping of the dilated heart and other devices only get discreet results. Experimental studies through myogenesis could be an alternative, but they are still in developmental phase. Therefore, cardiac transplantation is the alternative with best results but with a major limitation in graft availability. Following the comparative study between optimal medical treatment and left ventricular assist device (LVAD) in patients with heart congestive failure advanced (REMATCH) a new alternative has been opened with discreet results, although better survival in those patients treated with LVADs and even with better results in those patients who came into the study later on, probably due to more clinic experience. We can conclude that devices have improved, decreasing structural failures. There are new alternatives that try to solve main problems of this therapy as well as to unify criteria in anticoagulation treatment, antiplatelet therapy and most aggressive antibiotic prophylaxis.