Implantable v-entricular assist dev-ices: Should they be used in Québec?

Heart failure is common and until recently the last step in its management was cardiac transplantation. However, very few donor hearts are available each year. Mechanical pumps have now been developed which can be implanted in the body of the recipient and take over the heart's function, thus prolonging life for several months or years. These left ventricular assist devices (LVADs) are being used in Europe and the USA but have only very limited application in Canada and Quebec.

The present document examines the available data on the efficacy, associated complications and costs of LVADs and discusses thoroughly the ethical and social issues raised by their use. The report arose from a request by the Régie régionale de la santé et des services sociaux de Montréal-Centre; however, as the issue condemns the entire province, the Ministère de la Santé et des Services sociaux is very interested in the results of this evaluation.

As a result of its analysis, the Conseil d'évaluation des technologies de la santé (CETS) concludes that the LVAD is an effective technology that can be described as innovative. As such, its application should be considered only within the strict framework of data collection for research purposes.

However, consideration of the ethical and social issues leads CETS to suggest limited access to LVADs and their use only as a bridge to transplantation. Moreover, initiation of this technology should not take place without prior decision being taken on the following issues: number of implantations, number of LVAD centres, specific funds for these centres, need of a functional communication network between cardiac surgery centres, requirements for research, and the need of a periodic evaluation of the program.