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Related Experiment Videos

Left ventricular assist device performance with long-term circulatory support: lessons from the REMATCH trial.

Walter P Dembitsky1, Alfred J Tector, Soon Park

  • 1Sharp Memorial Hospital, San Diego, California, USA.

The Annals of Thoracic Surgery
|November 25, 2004
PubMed
Summary

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Left ventricular assist device (LVAD) implantation significantly improves survival for end-stage heart failure patients compared to medical management. While device malfunctions occur, ongoing innovations promise enhanced LVAD performance for long-term therapy.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Clinical Trials

Background:

  • Left ventricular assist device (LVAD) failure and malfunction rates are crucial for assessing long-term viability in heart failure patients.
  • Existing bridge-to-transplantation literature inadequately characterizes LVAD device performance metrics.

Purpose of the Study:

  • To compare survival rates between patients receiving LVAD implantation and those managed medically.
  • To evaluate LVAD device performance, including malfunction and system failure rates.

Main Methods:

  • The Randomized Evaluation of Mechanical Cardiac Support (REMS) trial compared optimal medical management with LVAD implantation.
  • Patient outcomes were adjudicated by an independent committee, with survival analyzed by intention-to-treat.

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  • Device performance was analyzed by disaggregating confirmed malfunctions and system failures.

    • Main Results:

    • One-year survival was 52% for LVAD patients versus 28% for medical patients; two-year survival was 29% for LVAD patients versus 13% for medical patients.
    • The system failure rate was 0.13 per patient-year, and the confirmed LVAD malfunction rate was 0.90.
    • Freedom from device replacement was 87% at 1 year and 37% at 2 years.

    Conclusions:

    • LVAD implantation offers a significant survival benefit over medical management for end-stage heart failure, despite observed device malfunction rates.
    • Future device modifications and improved infection management strategies are expected to enhance LVAD performance.