Ventricular assist devices and artificial hearts: Mechanical solutions to the biological problem of congestive heart failure

S ubstantial improvements have been made over the past 15 years in the treatment of acute cardiac illnesses. Patients are often carried through 1 or more episodes using medical or surgical therapies. From 1980 to 1993, the death rate from acute myocardial infarction (MI) decreased by 30%.’ However, the natural history of ischemic heart disease is rclentlessly progressive despite palliative ellbrts. Consequently, a conversion occurs from acute episodic illness to chronic disease. The final common pathway of many chronic cardiac diseases leads to muscular left ventricular (Lv) failure, manifest primarily as congestive heart failure (CHF). As stated by Eugene Braunwald in his editorial, “Cardiovascular Care at the Turn of the Millennium,” CHF is “one of two emerging epidemics of cardiovascular disease.” Z