WASHINGTON, DC (FEBRUARY 29, 2024) - A new State-of-the-Art Review released today in the Journal of Cardiac Failure (JCF) summarizes emerging technological innovations in durable mechanical circulatory support (MCS) devices in the areas of pump design, ancillary technology, and peri-and post-operative management. Primarily in late preclinical or early clinical stages of trial, these technologies have the potential to reshape the experience of future durable MCS patients. The authors represent a cross-disciplinary collaboration, written by expert engineers and clinicians from the US and Europe.
 
The Future of Durable Mechanical Circulatory Support – Emerging Technological Innovations and Considerations to Enable Evolution of the Field discusses the following innovations:  1) Pump design: transcutaneous energy transfer systems; novel left ventricular support devices that are in late preclinical or early clinical phases of trial; and total artificial hearts that are under development. 2) Peri-operative management: the use of advanced imaging, virtual implantation, computational modeling and benchtop hybrid mock circulatory loops to guide personalization of device selection and the implant procedure, 3) Advances in long-term management, including remote and continuous monitoring of device and hemodynamic parameters, sensor integration, automatic pump control, and patient phenotyping. 
 
“Durable mechanical circulatory support (MCS) is undoubtedly a life-saving therapy for patients with advanced heart failure, and the field has undergone a transformative evolution over the past three decades,” said lead author Aditi Nayak, MD, MS (Baylor University Medical Center). “However, the technological advancements outlined in our review show promise for revolutionizing patients’ experiences with durable MCS, with the potential for ‘un-tethered’ support, minimized anti-coagulation, individualization of device selection and management, and reduced occurrence of long-term adverse events such as aortic insufficiency and right heart failure. These advances are of course incumbent upon the collaboration of the MCS community of clinicians, engineers, industry partners and investors, and continued research in the field.”
 
The technologies in this review are subject to the typical lengthy lead times for innovations to evolve from the early clinical stage to adoption in clinical practice, regulatory and reimbursement considerations. If and when scaled, efforts must be taken to ensure equitable access to these therapies. Further research is needed to fill remaining gaps in understanding exercise physiology, and development of hemodynamic related adverse events in durable MCS patients.
 
The Future of Durable Mechanical Circulatory Support – Emerging Technological Innovations and Considerations to Enable Evolution of the Field is published online under Articles in Press at www.onlinejcf.com. 
 
DOI: 10.1016/j.cardfail.2024.01.011