ECMO and Ventricular Assist Devices as a Bridge to Transplant

Many cardiac diseases, like coronary artery disease and some viral cardiomyopathy over a period of time, give rise to the condition calledheart failure (HF).More than2million Indians suffer from HF today. The first line of management includes lifestyle modifications, as well as medical therapy. The latter uses drugs such as beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptors/blockers aldosterone antagonists, diuretics, digoxin, and many others keep getting added with more research and research and development today. Salt and fluid restriction too plays a pivotal role. Patients with a wide QRS complex in their electrocardiogram and thosehavingamoderate to severe symptomsofHFneed to have a cardiac resynchronization therapy and a patient with fatal arrhythmias needs an implantable defibrillator inserted as therapy. So, use of advanced mechanical therapies is a necessity in HF patient. Most HF Indians have class III or class IV symptoms of dyspnea at rest of some duration or a recent origin. In this scenario of advanced mechanical support in HF patient, the two definitive therapies of nearly 6,000 in number and still on the increase are the use of ventricular assist devices (VAD) and heart transplant,which havemet with some success (►Box 1). This editorial briefly revises extracorporeal membrane oxygenation (ECMO) as a bridge to transplant (►Figs. 1 and 2).