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Published on: July 18, 2014
Long-term use of a left ventricular assist device for end-stage heart failure
E A Rose1, A C Gelijns, A J Moskowitz
1College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Insights
Implantable left ventricular assist devices significantly improve survival and quality of life for advanced heart failure patients ineligible for transplantation. This study demonstrates their benefit as a viable alternative therapy.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Research
Background:
- End-stage heart failure necessitates advanced treatment options.
- Left ventricular assist devices (LVADs) are used as a bridge to transplant.
- Long-term survival and quality of life benefits of LVADs require evaluation.
Purpose of the Study:
- To evaluate the long-term efficacy of LVADs in end-stage heart failure patients.
- To compare LVAD therapy with optimal medical management.
- To assess survival benefit and quality of life improvements.
Main Methods:
- Randomized controlled trial involving 129 patients with New York Heart Association class IV heart failure.
- Patients were ineligible for cardiac transplantation.
- Assigned to either LVAD implantation (68 patients) or optimal medical management (61 patients).
Main Results:
- LVAD group showed a 48% reduction in all-cause mortality risk (P=0.001).
- One-year survival rates: 52% (LVAD) vs. 25% (medical management).
- Significant improvement in quality of life observed in the LVAD group at one year.
Conclusions:
- LVADs provide a clinically meaningful survival benefit for advanced heart failure.
- LVAD therapy significantly enhances the quality of life in selected patients.
- LVADs represent an acceptable alternative to transplantation for eligible patients.
Background:
Implantable left ventricular assist devices have benefited patients with end-stage heart failure as a bridge to cardiac transplantation, but their long-term use for the purpose of enhancing survival and the quality of life has not been evaluated.
Methods:
We randomly assigned 129 patients with end-stage heart failure who were ineligible for cardiac transplantation to receive a left ventricular assist device (68 patients) or optimal medical management (61). All patients had symptoms of New York Heart Association class IV heart failure.
Results:
Kaplan-Meier survival analysis showed a reduction of 48 percent in the risk of death from any cause in the group that received left ventricular assist devices as compared with the medical-therapy group (relative risk, 0.52; 95 percent confidence interval, 0.34 to 0.78; P=0.001). The rates of survival at one year were 52 percent in the device group and 25 percent in the medical-therapy group (P=0.002), and the rates at two years were 23 percent and 8 percent (P=0.09), respectively. The frequency of serious adverse events in the device group was 2.35 (95 percent confidence interval, 1.86 to 2.95) times that in the medical-therapy group, with a predominance of infection, bleeding, and malfunction of the device. The quality of life was significantly improved at one year in the device group.
Conclusions:
The use of a left ventricular assist device in patients with advanced heart failure resulted in a clinically meaningful survival benefit and an improved quality of life. A left ventricular assist device is an acceptable alternative therapy in selected patients who are not candidates for cardiac transplantation.
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