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Published on: May 11, 2018
Left ventricular device as destination therapy: are we there yet?
1Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada.
Current Opinion in Cardiology
|June 18, 2009
Summary
Second-generation left ventricular assist devices (LVADs) improve outcomes for destination therapy in heart failure patients. While survival remains a challenge, these advanced devices offer better durability and fewer adverse events.
Area of Science:
- Cardiology
- Medical Device Technology
- Heart Failure Management
Background:
- Mechanical circulatory support is shifting towards destination therapy for end-stage heart failure.
- The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial marked a pivotal point in this evolution.
- Outcomes with first-generation devices and newer second-generation left ventricular assist devices (LVADs) are under continuous evaluation.
Purpose of the Study:
- To review the evolution of outcomes in destination therapy for heart failure.
- To assess the impact of second-generation LVADs on patient outcomes and adverse events.
- To explore the future role of LVADs in heart failure treatment.
Main Methods:
- Review of post-REMATCH trial data for destination therapy patients.
- Analysis of outcomes associated with first-generation pulsatile flow devices.
- Evaluation of performance data for second-generation continuous axial flow devices.
Main Results:
- First-generation LVADs showed modest 2-year outcome improvements and reduced adverse events, but survival remains poor.
- Second-generation axial flow devices demonstrate enhanced durability and reliability.
- Significant reductions in sepsis and device-related infections were observed with second-generation devices in bridge-to-transplant settings.
Conclusions:
- Second-generation axial flow LVADs significantly improve the safety profile and longevity of mechanical circulatory support.
- Destination therapy is a viable option for select end-stage heart failure patients.
- Ongoing advancements in LVAD technology and clinical experience are expected to further enhance patient outcomes.
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