Durable mechanical circulatory support in end-stage heart failure: applications and future directions

doi:10.3877/cma.j.issn.2096-1537.2025.04.001

Abstract

Abstract:

Durable mechanical circulatory support, represented by the left ventricular assist device (LVAD), plays an important role in the treatment of patients with end-stage heart failure. The introduction of levitation technologies (magnetic or hydraulic) has substantially improved the hemocompatibility and survival of LVAD, further transforming the therapeutic philosophy for LVAD (evidenced by increased proportion of destination therapy). In the future, fully implantable LVADs will further improve patients' quality of life, while physiologically adaptive pulsatile pumps are expected to achieve even greater improvements in hemocompatibility. This article provides a review of the application of durable mechanical circulatory support (dMCS) in patients with end-stage heart failure, focusing on the current status of LVAD, its indications and timing of surgery, as well as future development directions.

Key words: Durable mechanical circulatory support, End-stage heart failure, Left ventricular assist device, Total artificial heart

Guangwei Hao, Xiaoning Sun, Guowei Tu, Zhe Luo. Durable mechanical circulatory support in end-stage heart failure: applications and future directions[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(04): 329-334.

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References 58

1	Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [J]. Circulation, 2022, 145(18): e895-e1032.
2	GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021 [J]. Lancet, 2024, 403(10440): 2100-2132.
3	Savarese G, Becher PM, Lund LH, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology [J]. Cardiovasc Res, 2023, 118(17): 3272-3287.
4	Costanzo MR, Mills RM, Wynne J. Characteristics of "stage D" heart failure: insights from the Acute Decompensated Heart Failure National Registry Longitudinal Module (ADHERE LM) [J]. Am Heart J, 2008, 155(2): 339-347.
5	中华医学会心血管病学分会, 中国医师协会心血管内科医师分会, 中国医师协会心力衰竭专业委员会, 等. 中国心力衰竭诊断和治疗指南2024 [J]. 中华心血管病杂志, 2024, 52(3): 235-275.
6	Jain R, Kransdorf EP, Cowger J, et al. Donor Selection for Heart Transplantation in 2025 [J]. JACC Heart Fail, 2025, 13(3): 389-401.
7	Theochari CA, Michalopoulos G, Oikonomou EK, et al. Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis [J]. Ann Cardiothorac Surg, 2018, 7(1): 3-11.
8	Yuzefpolskaya M, Schroeder SE, Houston BA, et al. The Society of Thoracic Surgeons Intermacs, 2022 Annual Report: focus on the 2018 Heart Transplant Allocation System [J]. Ann Thorac Surg, 2023, 115(2): 311-327.
9	Mehra MR, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device - final report [J]. N Engl J Med, 2019, 380(17): 1618-1627.
10	Wang X, Zhou X, Chen H, et al. Long-term outcomes of a novel fully magnetically levitated ventricular assist device for the treatment of advanced heart failure in China [J]. J Heart Lung Transplant, 2024, 43(11): 1806-1815.
11	Jorde UP, Saeed O, Koehl D, et al. The Society of Thoracic Surgeons Intermacs 2023 annual report: focus on magnetically levitated devicesⅡ [J]. Ann Thorac Surg, 2024, 117(1): 33-44.
12	Berardi C, Bravo CA, Li S, et al. The history of durable left ventricular assist devices and comparison of outcomes: HeartWare, HeartMate Ⅱ, HeartMate 3, and the future of mechanical circulatory support [J]. J Clin Med, 2022, 11(7): 2022.
13	Aslam S, Cowger J, Shah P, et al. The International Society for Heart and Lung Transplantation (ISHLT): 2024 infection definitions for durable and acute mechanical circulatory support devices [J]. J Heart Lung Transplant, 2024, 43(7): 1039-1050.
14	Mehra MR, Naka Y, Uriel N, et al. A fully magnetically levitated circulatory pump for advanced heart failure [J]. N Engl J Med, 2017, 376(5): 440-450.
15	Mehra MR, Goldstein DJ, Uriel N, et al. Two-year outcomes with a magnetically levitated cardiac pump in heart failure [J]. N Engl J Med, 2018, 378(15): 1386-1395.
16	Uriel N, Colombo PC, Cleveland JC, et al. Hemocompatibility-related outcomes in the MOMENTUM 3 trial at 6 months: a randomized controlled study of a fully magnetically levitated pump in advanced heart failure [J]. Circulation, 2017, 135(21): 2003-2012.
17	Mehra MR, Goldstein DJ, Cleveland JC, et al. Five-year outcomes in patients with fully magnetically levitated vs axial-flow left ventricular assist devices in the MOMENTUM 3 randomized trial [J]. JAMA, 2022, 328(12): 1233-1242.
18	Pagani FD, Cantor R, Cowger J, et al. Concordance of treatment effect: an analysis of The Society of Thoracic Surgeons Intermacs Database [J]. Ann Thorac Surg, 2022, 113(4): 1172-1182.
19	杜娟, 邹亮, 陈伊, 等. 中国左心室辅助装置植入术后早期重症监护管理专家共识 (2024年) [J]. 中国循环杂志, 2024, 39(8): 729-750.
20	Allen SR, Slaughter MS, Ahmed MM, et al. COMPETENCE Trial: the EVAHEART 2 continuous flow left ventricular assist device [J]. J Heart Lung Transplant, 2023, 42(1): 33-39.
21	Shore S, Golbus JR, Aaronson KD, et al. Changes in the United States adult heart allocation policy: challenges and opportunities [J]. Circ Cardiovasc Qual Outcomes, 2020, 13(10): e005795.
22	Stevenson LW, Pagani FD, Young JB, et al. INTERMACS profiles of advanced heart failure: the current picture [J]. J Heart Lung Transplant, 2009, 28(6): 535-541.
23	Shah KB, Starling RC, Rogers JG, et al. Left ventricular assist devices versus medical management in ambulatory heart failure patients: an analysis of INTERMACS Profiles 4 and 5 to 7 from the ROADMAP study [J]. J Heart Lung Transplant, 2018, 37(6): 706-714.
24	Starling RC, Estep JD, Horstmanshof DA, et al. Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: the ROADMAP study, 2-year results [J]. JACC Heart Fail, 2017, 5(7): 518-527.
25	Saeed D, Feldman D, Banayosy AE, et al. The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: a 10- year update [J]. J Heart Lung Transplant, 2023, 42(7): e1-e222.
26	Ni hIci T, Boardman HM, Baig K, et al. Mechanical assist devices for acute cardiogenic shock [J]. Cochrane Database Syst Rev, 2020, 6(6): Cd013002.
27	Boyle AJ, Ascheim DD, Russo MJ, et al. Clinical outcomes for continuous-flow left ventricular assist device patients stratified by pre-operative INTERMACS classification [J]. J Heart Lung Transplant, 2011, 30(4): 402-407.
28	Patel CB, Blue L, Cagliostro B, et al. Left ventricular assist systems and infection-related outcomes: a comprehensive analysis of the MOMENTUM 3 trial [J]. J Heart Lung Transplant, 2020, 39(8): 774-781.
29	Gasparovic H, Krzelj K. Current perspectives on durable ventricular assist devices [J]. Heart Surg Forum, 2024, 27(11): E1367-E1369.
30	Waters BH, Park J, Bouwmeester JC, et al. Electrical power to run ventricular assist devices using the Free-range Resonant Electrical Energy Delivery system [J]. J Heart Lung Transplant, 2018, 37(12): 1467-1474.
31	Jahangiri P, Veen KM, van Moort I, et al. Early postoperative changes in von willebrand factor activity are associated with future bleeding and stroke in HeartMate 3 patients [J]. ASAIO J, 2025, 71(1): 27-35.
32	Crow S, John R, Boyle A, et al. Gastrointestinal bleeding rates in recipients of nonpulsatile and pulsatile left ventricular assist devices [J]. J Thorac Cardiovasc Surg, 2009, 137(1): 208-215.
33	Mohamed MS, Shehadah A, Hashem A, et al. Gastrointestinal bleeding in patients supported with left ventricular assist devices: the journey from bridging to destination [J]. Am J Cardiol, 2023, 201: 71-77.
34	Purohit SN, Cornwell WK 3rd, Pal JD, et al. Living without a pulse: the vascular implications of continuous-flow left ventricular assist devices [J]. Circ Heart Fail, 2018, 11(6): e004670.
35	Cheng A, Williamitis CA, Slaughter MS. Comparison of continuous-flow and pulsatile-flow left ventricular assist devices: is there an advantage to pulsatility? [J]. Ann Cardiothorac Surg, 2014, 3(6): 573-581.
36	Kuroda T, Miyagi C, Polakowski AR, et al. Preservation of pulsatility with universal ventricular assist device: in vitro assessment for biventricular support [J]. Artif Organs, 2024, 48(2): 182-190.
37	Ferrari A, Giampietro C, Bachmann B, et al. A novel hybrid membrane VAD as first step toward hemocompatible blood propulsion [J]. Ann Biomed Eng, 2021, 49(2): 716-731.
38	Figueiredo C, Eicke D, Yuzefovych Y, et al. Low immunogenic endothelial cells endothelialize the left ventricular assist device [J]. Sci Rep, 2019, 9(1): 11318.
39	Birati EY, Grandin EW, Zhang RS, et al. Outcomes following isolated right ventricular assist device as durable support for primary right heart failure: an INTERMACS analysis [J]. JHLT Open, 2025, 8: 100258.
40	Hanuna M, Kaab S, Hagl C, et al. Do it "RIGHT": HeartMate 3 as destination therapy right ventricular assist device in a patient with arrhythmogenic right ventricular cardiomyopathy [J]. ASAIO J, 2023, 69(1): e46-e48.
41	Ricklefs M, Hanke JS, Dogan G, et al. Successful HeartMate 3 implantation in isolated right heart failure-first in man experience of right heart configuration [J]. J Thorac Dis, 2018, 10(Suppl 15): S1834-S1837.
42	McGiffin D, Kure C, McLean J, et al. The results of a single-center experience with HeartMate 3 in a biventricular configuration [J]. J Heart Lung Transplant, 2021, 40(3): 193-200.
43	Kormos RL, Teuteberg JJ, Pagani FD, et al. Right ventricular failure in patients with the HeartMate Ⅱ continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes [J]. J Thorac Cardiovasc Surg, 2010, 139(5): 1316-1324.
44	Dang NC, Topkara VK, Mercando M, et al. Right heart failure after left ventricular assist device implantation in patients with chronic congestive heart failure [J]. J Heart Lung Transplant, 2006, 25(1): 1-6.
45	Siems C, Aggarwal R, Shaffer A, et al. Right heart failure after left ventricular assist device implantation: a persistent problem [J]. Indian J Thorac Cardiovasc Surg, 2023, 39(Suppl 1): 161-169.
46	Miller T, Lang FM, Rahbari A, et al. Right heart failure after durable left ventricular assist device implantation [J]. Expert Rev Med Devices, 2024, 21(3): 197-206.
47	Adamopoulos S, Bonios M, Ben Gal T, et al. Right heart failure with left ventricular assist devices: preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC [J]. Eur J Heart Fail, 2024, 26(11): 2304-2322.
48	Potapov EV, Schoenrath F, Falk V. Clinical signs of right ventricular failure following implantation of a left ventricular assist device [J]. Eur J Heart Fail, 2020, 22(2): 383-384.
49	Coselli JS. Nothing like a good feud to spark competition: first use of the total artificial heart [J]. Artif Organs, 2022, 46(1): 8-13.
50	Stevens E, Lampert BC, Whitson BA, et al. Total artificial heart implantation: supportive care preparedness planning framework [J]. BMJ Support Palliat Care, 2023: spcare-2023-004210.
51	Noly PE, Ben Ali W, Lamarche Y, et al. Status, indications, and use of cardiac replacement therapy in the era of multimodal mechanical approaches to circulatory support: a scoping review [J]. Can J Cardiol, 2020, 36(2): 261-269.
52	Cook JA, Shah KB, Quader MA, et al. The total artificial heart [J]. J Thorac Dis, 2015, 7(12): 2172-2180.
53	Arabia FA, Murray CF. The total artificial heart: where have we been, where are we now, where are we going? [J]. Indian J Thorac Cardiovasc Surg, 2023, 39(Suppl 1): 198-205.
54	Carpentier A, Latremouille C, Cholley B, et al. First clinical use of a bioprosthetic total artificial heart: report of two cases [J]. Lancet, 2015, 386(10003): 1556-1563.
55	Carpentier A, Deloche A, Relland J, et al. Six-year follow-up of glutaraldehyde-preserved heterografts. With particular reference to the treatment of congenital valve malformations [J]. J Thorac Cardiovasc Surg, 1974, 68(5): 771-782.
56	Ferrall J, Vaidya AS, Kawaguchi ES, et al. Comparison of waitlist and post-transplant outcomes in patients supported with total artificial heart versus continuous biventricular assist devices [J]. Artif Organs, 2025, 49(2): 281-291.
57	Cheng A, Trivedi JR, Van Berkel VH, et al. Comparison of total artificial heart and biventricular assist device support as bridge-to-transplantation [J]. J Card Surg, 2016, 31(10): 648-653.
58	Shah P, Yuzefpolskaya M, Hickey GW, et al. Twelfth interagency registry for mechanically assisted circulatory support report: readmissions after left ventricular assist device [J]. Ann Thorac Surg, 2022, 113(3): 722-737.

产品参数	CH-VAD	Heart-Con	CorHeart 6	EVA-Pulsar^TM	HeartMate 3
制造商	苏州同心医疗	航天泰心	深圳核心医疗	重庆永仁心医疗	美国雅培
轴承原理	全磁悬浮	磁液悬浮	全磁悬浮	液力悬浮	全磁悬浮
泵体直径（mm）	47	50	33	51	50.3
泵体高度（mm）	25	22	26	67.5	33.8
重量（g）	186	184	90	262	200
出血管直径（mm）	10	10	12	14	14
转速（转/min）	1000~4200	2000~3400	2200~4300	1600~2400	3000~9000
功耗（W）	5~8	2~6	1.5~7	3~6	3~4
最大流量（L/min）	10	10	10	20	10
中国获批时间	2021年11月	2022年7月	2023年6月	2024年2月	2024年7月

产品参数	CH-VAD	Heart-Con	CorHeart 6	EVA-Pulsar^TM	HeartMate 3
制造商	苏州同心医疗	航天泰心	深圳核心医疗	重庆永仁心医疗	美国雅培
轴承原理	全磁悬浮	磁液悬浮	全磁悬浮	液力悬浮	全磁悬浮
泵体直径（mm）	47	50	33	51	50.3
泵体高度（mm）	25	22	26	67.5	33.8
重量（g）	186	184	90	262	200
出血管直径（mm）	10	10	12	14	14
转速（转/min）	1000~4200	2000~3400	2200~4300	1600~2400	3000~9000
功耗（W）	5~8	2~6	1.5~7	3~6	3~4
最大流量（L/min）	10	10	10	20	10
中国获批时间	2021年11月	2022年7月	2023年6月	2024年2月	2024年7月

适应证	禁忌证
适应证	相对	绝对
因心力衰竭频繁住院	年龄＞80岁	不可逆的肝、肾或神经系统功能不全
最大剂量药物治疗情况下仍表现为NYHA心功能分级ⅢB~Ⅳ级	未治疗的恶性肿瘤	依从性差
无法耐受神经内分泌拮抗剂	不愿意终止的药物滥用	严重的社会心理学障碍
利尿剂剂量增加	活动性感染或长期气管插管
心脏再同步化治疗后仍存在心力衰竭症状	重度肥胖或营养不良
强心药依赖	严重的周围血管疾病
最大摄氧量下降[VO2max＜14～16 ml/（kg•min）]	影响术后康复的肌肉骨骼疾病
低心输出量导致终末器官功能不全	未治疗的精神疾病、认知功能障碍或社会家庭支持不足

适应证	禁忌证
适应证	相对	绝对
因心力衰竭频繁住院	年龄＞80岁	不可逆的肝、肾或神经系统功能不全
最大剂量药物治疗情况下仍表现为NYHA心功能分级ⅢB~Ⅳ级	未治疗的恶性肿瘤	依从性差
无法耐受神经内分泌拮抗剂	不愿意终止的药物滥用	严重的社会心理学障碍
利尿剂剂量增加	活动性感染或长期气管插管
心脏再同步化治疗后仍存在心力衰竭症状	重度肥胖或营养不良
强心药依赖	严重的周围血管疾病
最大摄氧量下降[VO2max＜14～16 ml/（kg•min）]	影响术后康复的肌肉骨骼疾病
低心输出量导致终末器官功能不全	未治疗的精神疾病、认知功能障碍或社会家庭支持不足

首字母	英文	中文
I	IV inotropes	静脉正性肌力药物
N	NYHA ⅢB/Ⅳ or persistently elevated natriuretic peptides	NYHA ⅢB/Ⅳ级，或BNP 持续升高
E	End-organ dysfunction	终末器官功能不全
E	EF≤35%	EF≤35%
D	Defibrillator shocks	ICD放电
H	Hospitalizations ＞1	住院大于1次
E	Edema despite escalating diuretics	利尿剂不断增加，水肿持续存在
L	Low blood pressure，high heart rate	血压低、心率快
P	Progressive intolerance or down titration of GDMT	不能耐受或下调指南导向的药物治疗

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