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VIEWPOINT

Same Bridge, New Destinations

Rethinking Paradigms for Mechanical Cardiac Support in Heart Failure

Duke University School of Medicine, Durham, North Carolina

Manuscript received August 30, 2005; accepted September 29, 2005.

^_* Address reprint requests: Dr. G. Michael Felker, Duke Clinical Research Institute, 2400 Pratt Street, Room 0311 Terrace Level, Durham, North Carolina 27705. (Email: michael.felker{at}duke.edu).

Mechanical cardiac support with ventricular assist devices is an established therapy for a variety of clinical scenarios, including postcardiotomy shock, "bridge to transplant," and "destination therapy." At present, device development, clinical trial design, regulatory approval, and reimbursement decisions for the clinical application of mechanical cardiac support devices continue to be considered in the context of these clinical indications. Although understandable from a historical perspective, these arbitrary divisions are inconsistent with the clinical realities of advanced heart failure therapy. By narrowly focusing on transplant eligibility at a static point in the clinical course, current guidelines impede the broader application of ventricular assist device technology to the growing population of patients who may benefit from this therapy.

Abbreviations and Acronyms   REMATCH = Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure   VAD = ventricular assist device

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