Implantable ventricular assist devices (VADs), mechanical pumps that support the action of the patient's damaged ventricles, were originally developed to allow ventricular unloading during recovery from acute reversible CHF and as a bridge to transplantation in cases where the myocardial damage is irreversible and external support must be sustained. More recently, VAD use has become standard of care in many transplant centers for many patients with severe end-stage heart disease refractory to Optimal Medical Management (OMM). The proportion of patients receiving a heart transplant with a mechanical circulatory support device (MCSD) in place at the time of transplant has risen to > 40% according to the January 2011 report from the Scientific Registry of Transplant recipients (SRTR). This compares to 34.9% in January 2010 and 31.1% in July 2009. This represents a 27% increase in one year in the use of MCSDs in pretransplant patients. The majority of these devices are VADs. The HeartMate II and the HeartWare LVAS account for a large majority of LVADS implanted in 2011. At this time, the cost of VAD implantation and management pre-transplant compares to the cost of a completed heart transplant effectively doubling the cost of heart transplantation for those patients who have a VAD implanted as Bridge to Transplant. The newer devices provide the opportunity for many years of good quality of life for those patients who will not receive a heart transplant (Destination Therapy). With the newer devices, there will be an increasing number of patients eligible to receive this very costly but potentially life-saving therapy. Appropriate patient selection and device management are crucial to the successful application of this evolving technology.

Learning Objectives
At the end of this educational activity, participants should be able to

1. Describe the principles of advanced heart failure management and the role of VADs
2. Identify the commonly used VADs that are FDA approved and their indications
3. Discuss the complications associated with VADs with a bridge to transplant or destination therapy
4. Review the case manager’s role post-device implantation

Method of Participation
For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
Participants will receive a certificate upon successful completion of the activity, which includes the following:

• Attending the live activity
• Completing the Post-Activity Assessment, Activity Evaluation, and Application for Certificate of Credit forms

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Faculty Listing
Dennis Irwin, MD
National Medical Director, Transplant and VAD
OptumHealth

Faculty Disclosure
As a sponsor accredited by the ACCME, OptumHealth Education requires the disclosure of all relevant financial relationships a faculty member has with any commercial interest. The faculty reported the following:
Dr Irwin is an employee of OptumHealth Care Solutions.
Dr Irwin does not intend to discuss unapproved/investigative use of commercial products/devices.

Staff Disclosures
In compliance with the ACCME's Standards for Commercial Support, employees of OptumHealth Education who have control over content of an activity are required to disclose their relevant financial relationships. No employee has a relevant financial relationship regarding this activity.

Activity Planners
Karen Babos, DO, MBA
Senior National Medical Director
OptumHealth Complex Medical Conditions

Rebecca Gleason, RN, CCM
Manager, Clinical Programs
OptumHealth Education

Barbara Lindberg, JD, RN
Lead Nurse Planner
OptumHealth Education

Sponsored By
This activity is sponsored by OptumHealth Education.

Commercial Support
There was no commercial support received for this activity.

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