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conAs a surgeon practicing in a cardiothoracic center with a large experience in MCS implant and management, I would like to raise some concerns regarding the opinions posted in the July issue of the Links Newsletter advocating strict rules to regulate MCS use.

The major point we should take into consideration is that these devices truly represent a revolutionary technology that is going to re-shape the way we think about heart failure. As healthcare professionals, we cannot accept that third parties or governments may limit and/or prioritize the access to this therapeutic option, based on criteria other than rigorous clinical judgment. This would represent an unacceptable limitation to the individual's rights to receive the best therapeutic treatment available.

While no western country government would restrict transplants because of economical reasons, we are facing a spontaneous restriction of transplant availability. Thus, VAD implantation rapidly is becoming our first and only option to save the lives of patients with heart failure. Nevertheless, we should strive to refine indications, improve techniques and managements, and produce robust evidences to have this therapy offered to all who can gain benefit. We cannot limit innovation fearing lack of resources. To have "VAD therapy become for heart failure what dialysis is for kidney failure," as forecasted in last month's letter, it cannot be restricted to transplant centers only. Is dialysis restricted only to kidney transplant centers?

All experienced cardiothoracic centers should have the possibility to implant VAD: increasing numbers will be accompanied by lowering costs. Of course, as for any surgical procedure, training, communication with more experienced centers, and auditing of the results will be a key factor that will help to improve results and accessibility of this procedure.

ISHLT cannot lose the chance to be active part in this revolution and I do believe that our Society has the scientific and organizational resources to be the educational hub through which experienced and naïve centers can collaborate to improve VAD therapy; the international registry that was announced a few months ago is an important step towards this direction.

Dr Gino Pultz


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