TY - JOUR
T1 - History and Application of Mechanical Assist Devices as a Bridge to Heart Transplant
T2 - A Review and Perspectives in Brazil
AU - Perazzo, Alvaro
AU - Gaiotto, Fabio Antonio
AU - Steffen, Samuel Padovani
AU - Gaspar, Shirlyne Fabianni Dias
AU - Faria, Vanessa Simioni
AU - Ferreira, Rebeca Cavalcante Silva
AU - Carbonera, Aline
AU - Guazzelli, Danielle Louvet
AU - Gamboa, Jael Andrea Rioja
AU - Ideal, Leonardo Flud
AU - Gomes, Helen Lima
AU - Filho, Alexandre Targino Gomes Falcao
AU - Fernandes, Andre Loureiro
AU - Campos, Luiza Hermanny
AU - Steffen, Camila Lambert
AU - Limongi, Carolina
AU - Varjao, Renato Leal
AU - Avila, Monica Samuel
AU - Seguro, Luis Fernando Bernal da Costa
AU - Mangini, Sandrigo
AU - Marcondes-Braga, Fabiana Goulart
AU - Aulicino, Gabriel Barros
AU - de Campos, Iascara Wozniak
AU - Santos, Ronaldo Honorato Barros
AU - Filho, Domingos Dias Lourenco
AU - Kowalewski, Mariusz
AU - Ronco, Daniele
AU - Matteucci, Matteo
AU - Meani, Paolo
AU - Russo, Claudio Francesco
AU - di Mauro, Michele
AU - Mariani, Silvia
AU - Loforte, Antonio
AU - Wiedmann, Dominik
AU - Bacal, Fernando
AU - Whitman, Glenn
AU - Punjabi, Prakash
AU - Lorusso, Roberto
AU - Jatene, Fabio B.
PY - 2025
Y1 - 2025
N2 - INTRODUCTION: Mechanical circulatory support (MCS) devices have evolved significantly over the past decades and play a vital role in managing end-stage heart failure, especially as a bridge to heart transplantation. From the pioneering heart-lung machines to third-generation ventricular assist devices (VADs), MCS technology has advanced to provide more durable, efficient, and safer options for both short- and long-term support. This review outlines the historical development of mechanical assist devices, the types of available supports - ranging from intra-aortic balloon pumps and extracorporeal membrane oxygenation to implantable devices like HeartMate 3 - and their clinical indications and complications. Special attention is given to right ventricular dysfunction, thromboembolic and hemorrhagic complications, and infections, which remain major challenges in the management of patients with MCS devices. In Brazil, despite the growing evidence supporting MCS in critically ill patients, access remains limited due to financial and systemic constraints. The review explores the current landscape of device availability in the country, national guidelines, cost-effectiveness data, and the impact of recent changes in transplant allocation criteria that prioritize patients receiving mechanical support. Notably, the approval of long-term VADs for destination therapy in the public health system in 2024 marks a significant milestone. This review offers a comprehensive perspective on MCS utilization, highlighting both global advances and Brazil-specific challenges. By identifying gaps in access and proposing future directions, it advocates for expanded use of these life-saving technologies to improve survival and quality of life in advanced heart failure patients.
AB - INTRODUCTION: Mechanical circulatory support (MCS) devices have evolved significantly over the past decades and play a vital role in managing end-stage heart failure, especially as a bridge to heart transplantation. From the pioneering heart-lung machines to third-generation ventricular assist devices (VADs), MCS technology has advanced to provide more durable, efficient, and safer options for both short- and long-term support. This review outlines the historical development of mechanical assist devices, the types of available supports - ranging from intra-aortic balloon pumps and extracorporeal membrane oxygenation to implantable devices like HeartMate 3 - and their clinical indications and complications. Special attention is given to right ventricular dysfunction, thromboembolic and hemorrhagic complications, and infections, which remain major challenges in the management of patients with MCS devices. In Brazil, despite the growing evidence supporting MCS in critically ill patients, access remains limited due to financial and systemic constraints. The review explores the current landscape of device availability in the country, national guidelines, cost-effectiveness data, and the impact of recent changes in transplant allocation criteria that prioritize patients receiving mechanical support. Notably, the approval of long-term VADs for destination therapy in the public health system in 2024 marks a significant milestone. This review offers a comprehensive perspective on MCS utilization, highlighting both global advances and Brazil-specific challenges. By identifying gaps in access and proposing future directions, it advocates for expanded use of these life-saving technologies to improve survival and quality of life in advanced heart failure patients.
KW - Cardiac Surgical Procedures
KW - Postoperative Care
KW - Noninvasive Ventilation
KW - Systematic Review
KW - INTRAAORTIC BALLOON PUMP
KW - CIRCULATORY SUPPORT
KW - INTERNATIONAL SOCIETY
KW - MYOCARDIAL-INFARCTION
KW - FAILURE
KW - GUIDELINES
KW - OUTCOMES
U2 - 10.21470/1678-9741-2025-0906
DO - 10.21470/1678-9741-2025-0906
M3 - (Systematic) Review article
SN - 0102-7638
VL - 40
JO - Revista Brasileira de Cirurgia Cardiovascular
JF - Revista Brasileira de Cirurgia Cardiovascular
IS - 6
M1 - e20250906
ER -