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Permanent ventricular assist device support versus cardiac transplantation
D G Pennington1, T E Oaks, D P Lohmann
1Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. gpenning@wfubmc.edu
The Annals of Thoracic Surgery
|September 4, 1999
Summary
Permanent ventricular assist systems (LVASs) offer a promising alternative to heart transplantation, especially for patients facing donor organ scarcity and poorer outcomes with traditional transplants. LVASs may provide a more accessible and effective solution for advanced heart failure.
Area of Science:
- Cardiology
- Medical Devices
- Transplantation Medicine
Background:
- Cardiac transplantation is limited by donor organ availability, long-term survival rates, and patient comorbidities.
- Temporary ventricular assist devices (VADs) show promise as a potential alternative to transplantation.
- Permanent, fully implantable devices may offer a viable solution for end-stage heart failure.
Purpose of the Study:
- To compare the outcomes of heart transplantation with ventricular assist devices (VADs).
- To identify patient subgroups who would most benefit from permanent left ventricular assist systems (LVASs).
- To evaluate LVASs as a competitive alternative to cardiac transplantation.
Main Methods:
- Analysis of the 1997 International Society for Heart and Lung Transplantation (ISHLT) Registry data.
- Literature review on heart transplantation and VADs.
- Comparison of survival and complication rates between transplantation and VADs.
Main Results:
- Negative prognostic factors for heart transplant receipt include UNOS status II, O blood type, weight >180 lb, older age, and preformed antibodies.
- Women and nonwhite patients experience poorer outcomes post-transplantation.
- Wearable VADs show success, suggesting suitability for certain patients over transplantation.
Conclusions:
- LVASs can be readily manufactured and available, bypassing transplant waiting lists.
- LVASs present a competitive strategy compared to traditional cardiac transplantation.
- Permanent LVASs may offer improved outcomes and accessibility for heart failure patients.