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Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
Published on: May 11, 2018
Improving outcomes with long-term "destination" therapy using left ventricular assist devices.
James W Long1, Aaron H Healy, Brad Y Rasmusson
1Utah Artificial Heart Program, LDS Hospital, Salt Lake City, Utah 84143, USA. jimlong@ihc.com
The Journal of Thoracic and Cardiovascular Surgery
|June 12, 2008
Summary
Destination therapy with left ventricular assist devices significantly improves survival for advanced heart failure patients. This approach shows a 66% mortality reduction compared to earlier trials, offering outcomes potentially nearing heart transplantation.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Advanced heart failure necessitates innovative treatment options.
- Long-term left ventricular assist devices (LVADs) offer a potential solution for patients ineligible for heart transplantation.
- The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial established initial benchmarks for LVADs.
Purpose of the Study:
- To analyze the long-term destination therapy (DT) experience with LVADs.
- To compare outcomes of contemporary DT with the historical REMATCH trial data.
- To evaluate the potential for improving advanced heart failure treatment through LVADs.
Main Methods:
- Retrospective analysis of the largest single-center DT experience in the US (n=23).
- Patients received HeartMate LVADs, with 87% using the improved XVE model.
- Survival and adverse events were compared to the REMATCH LVAD group (n=68) using Kaplan-Meier and Poisson regression analyses.
Main Results:
- DT group showed significantly increased survival (P = .007), with a 66% overall mortality reduction.
- Two-year survival was 77% for DT versus 29% for REMATCH (P < .0001).
- Adverse events decreased by 38% in the DT group compared to the REMATCH group.
Conclusions:
- Long-term destination therapy with LVADs can significantly improve outcomes beyond the initial REMATCH trial.
- Advancements in devices, management, and patient selection are key to enhancing DT efficacy.
- Achieving outcomes comparable to heart transplantation is a potential future goal for destination therapy.
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