# History and Application of Mechanical Assist Devices as a Bridge to Heart Transplant: A Review and Perspectives in Brazil

## TL;DR

This review discusses the history and use of mechanical heart support devices, focusing on their role in bridging patients to heart transplants and challenges in Brazil.

## Contribution

The paper provides a comprehensive review of MCS devices and their application in Brazil, highlighting recent policy changes and access barriers.

## Key findings

- MCS devices have evolved to offer more durable and efficient support for heart failure patients.
- Right ventricular dysfunction and complications like infections remain major challenges in MCS management.
- Brazil's public health system approved long-term VADs for destination therapy in 2024, marking a significant milestone.

## Abstract

Mechanical circulatory support (MCS) devices have evolved significantly over the past
decades and play a vital role in managing end-stage heart failure, especially as a bridge
to heart transplantation. From the pioneering heart-lung machines to third-generation
ventricular assist devices (VADs), MCS technology has advanced to provide more durable,
efficient, and safer options for both shortand long-term support. This review outlines the
historical development of mechanical assist devices, the types of available supports -
ranging from intra-aortic balloon pumps and extracorporeal membrane oxygenation to
implantable devices like HeartMate 3 - and their clinical indications and complications.
Special attention is given to right ventricular dysfunction, thromboembolic and
hemorrhagic complications, and infections, which remain major challenges in the management
of patients with MCS devices.

In Brazil, despite the growing evidence supporting MCS in critically ill patients, access
remains limited due to financial and systemic constraints. The review explores the current
landscape of device availability in the country, national guidelines, cost-effectiveness
data, and the impact of recent changes in transplant allocation criteria that prioritize
patients receiving mechanical support. Notably, the approval of long-term VADs for
destination therapy in the public health system in 2024 marks a significant milestone.

This review offers a comprehensive perspective on MCS utilization, highlighting both
global advances and Brazil-specific challenges. By identifying gaps in access and
proposing future directions, it advocates for expanded use of these life-saving
technologies to improve survival and quality of life in advanced heart failure
patients.