Cardiac Assist Devices by Drs. Daniel J. Goldstein and Mehmet C. Öz is a timely new book that describes the evolution and application of the new devices that have been developed to augment or replace the function of the failing heart. The book focuses on the left ventricular assist device (LVAD). This is the most widely used device now, and will probably continue to be the primary heart assist device in the future.
The book is timely because the devices it describes seem destined to revolutionize the treatment of patients whose condition has left them with virtually no option. Many researchers have predicted that the new generation of devices will begin to replace transplantation, perhaps in the next 5 to 7 years, a development that would be of tremendous importance as the availability of donated organs continues to dwindle in comparison with the number of patients who need them.
The book is divided into 3 sections. Part 1 begins with a chapter that provides historical perspective on the evolution of mechanical circulatory support. Sub-sequent chapters discuss various aspects of the use of these devices, including patient selection; assessment and management of complications (primarily during the perioperative period, when most complications occur); the concept of “bridge to recovery”; and economic issues. There is also a chapter that covers the basic-science concepts underlying the hemodynamics and immunologic processes associated with the blood-device interface.
The 9 chapters of Section 2 describe the currently available devices and consider their respective strengths and weaknesses. Future devices, many of which are already in human trials, are also discussed. Most exciting of these are the axial flow devices, which are completely portable and hold great promise for resolving many of the severe complications encountered with the currently available devices.
The concept of bridge to recovery, in which the LVAD is used to support the failing heart for a period of months until it recovers, is now receiving intensive investigation and should gain acceptance within the next few years as a treatment for patients whose cardiomyopathy is potentially reversible. This promising development is mentioned in the book, but it should have received more emphasis and wider discussion.
Another limitation of the book is that it does not adequately discuss which devices are best for which patient populations, nor does it offer advice to physicians and administrators of an institution for choosing which mechanical circulatory support capabilities will best suit their facilities. Despite these flaws, Cardiac Assist Devices fills an important need by covering a fast-growing field in cardiac medicine and surgery.
The audience for this book should include cardiac surgeons, cardiologists, administrators of institutions that are interested in developing cardiac assist capabilities, and researchers in the field of heart failure. Assist device technology holds great promise, both for improving quality and length of life in heart failure patients and in reducing the ever-rising costs associated with medical management of heart failure.