Intensive Care Network Podcasts

Both cardiac transplantation and durable mechanical support with ventricular assist devices (VADs) have a parallel history – poor results to begin with followed by progressively improving results with more targeted immunosuppression, better recipient selection, improved diagnosis and treatment of rejection and opportunistic infections (cardiac transplantation) and a major step forward with replacement of pulsatile pumps by continuous flow devices (VADs).  Heart transplantation continues to be regarded as the gold standard therapy for end stage heart disease and that is why there is a rather artificial VAD indication classification – bridge to decision, bridge to transplantation and destination therapy.  It is the dynamic nature of heart failure and its treatment that may mean a VAD patient may move in and out of these designations.  This would argue for a single designation – indication for a VAD.    The automatic assumption that patients who have a VAD implanted should proceed with listing for cardiac transp