Ventricular Assist Devices and artificial Heart Cardiology Clinics february 2003

Foreword
Ventricular assist devices and the artificial heart

The current approach to chronic heart failure
management is to pharmacologically block every
neurohormonal compensatory mechanism for
which a drug is available. Although this approach
has significantly reduced morbidity and mortality,
the gains have been modest. Also, this treatment
paradigm has lead to a growing polypharmacy ap-
proach as blocking agents for every cytokine are
developed. In addition, it has become almost im-
possible to determine if a new agent is superior to
older agents, because clinical studies can only
be ethically designed to include all known bene-
ficial agents in the comparison group. Thus,
many believe that the current approach has
peaked.
Although cardiac transplantation has been
viewed as a better solution, much as it has domi-
nated the management of end stage renal dis-
ease, it has never reached its potential because of
a variety of factors: lack of organs, long-term
complications of immunosuppression, and the de-
bilitating effects of cardiac denervation. The new
therapeutic approach to heart failure involves sur-
gical device therapy. Cardiac resynchronization
therapy with biventricular pacing is taking off.
Automatic implantable cardioverter-defibrilla-
tors are markedly reducing the mortality associ-
ated with ventricular arrhythmias. Also, surgical
approaches including revascularization, ventricu-
lar reshaping, and valve repair and replacement
are gaining in popularity.
In this issue of the Cardiology Clinics, Drs.
Samuels and Narula, a cardiothoracic surgeon and
cardiologist, respectively, team up to guest edit a
collection of articles on mechanical ventricular
assist devices and the artificial heart. They have
assembled a stellar group of experts to discuss
every aspect of mechanical support/replacement
of the heart. How much such device therapy on
top of pharmacologic therapy will impact the mor-
bidity and mortality of heart failure is unknown,
but could be considerable. In the future gene-
based therapy may supersede current therapies,
but the full realization of the approach is a
long way off. In the meantime, cardiologists
need to be kept up-to-date on the latest devices,
largely because patients frequently hear about
them in the press. This issue will answer any
questions physicians and patients have about
these devices.
Michael H. Crawford, MD
Mayo Clinic Scottsdale
Scottsdale, AZ, USA
Michael H. Crawford, MD
0733-8651/03/$ - see front matter Ó 2003, Elsevier Science (USA). All rights reserved.
doi:10.1016/S0733-8651(03)00008-0
Cardiol Clin 21 (2003) xiii