Mechanical circulatory support in the UK

doi:10.1136/bmj.39053.636319.2C

BMJ 2007;334:167-168 (27 January), doi:10.1136/bmj.39053.636319.2C

Editorials

Mechanical circulatory support in the UK

It is time to do a trial of left ventricular assist devicesfor lifetime use

The first 150 words of the full text of this article appear below.

In June the National Institute for Health andClinical Excellence (NICE) published welcome but bewilderingguidelines for short term circulatory support with left ventricularassist devices (LVADs) as a bridge to cardiac transplantationor recovery.¹ Welcome because the guidelines will support fundingof these devices but bewildering because few, if any, guidelinesfor use were actually provided. The limited evidence was derivedfrom the USA and Europe, where LVADs have been used for 20 years,and the guidelines are silent on a third potential use for thesedevices—their longer term use as a lifetime treatment.

First generation LVADs were designed to replacethe failing left ventricle by providing stroke volume and pulsatileblood flow. Blood is taken from the ventricle and pumped ina pulsatile manner into the aorta at a rate of 4-10 litres perminute. These devices provide symptomatic relief, reverse multi-organdysfunction, and reduce the cytokine and . . . [Full text of this article]

Stephen Westaby, professor of biomedical science and consultant cardiac surgeon¹, Philip Poole-Wilson, professor of cardiology²

¹ John Radcliffe Hospital, Oxford OX3 9DU, ² National Heart and Lung Institute, Imperial College London, London SW3 6LY

westaby@AHF.org.uk