Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device

Area of Science:

• Cardiovascular Medicine
• Medical Devices
• Transplantation Surgery

Background:

• Left ventricular assist device (LVAD) therapy is crucial for advanced heart failure management.
• Continuous-flow rotary LVADs offer design advantages over pulsatile devices for extended support.
• These devices aim for smaller size and enhanced reliability through simplified pumping mechanisms.

Purpose of the Study:

• To evaluate the efficacy of continuous-flow rotary LVADs as a bridge to heart transplantation.
• To assess survival, transplantation rates, and adverse events in patients receiving LVAD support.

Main Methods:

• Prospective, multicenter study involving 281 patients urgently listed for heart transplantation (status 1A or 1B).
• Implantation of a continuous-flow LVAD.
• Assessment of survival and transplantation at 18 months; evaluation of adverse events, quality of life, functional status, and organ function at 6 months.

Main Results:

• 79% of patients (222/281) underwent transplantation, had LVAD removal for recovery, or continued LVAD support at 18 months.
• Actuarial survival on support was 72% at 18 months.
• Significant improvements observed at 6 months in functional status (NYHA class I/II: 0% to 83%) and quality of life (MLWHF: +41%, KCCQ: +75%). Major adverse events included bleeding, stroke, right heart failure, and infection; pump thrombosis occurred in 4 patients.

Conclusions:

• Continuous-flow LVADs provide effective hemodynamic support for patients awaiting heart transplantation.
• The devices significantly improve functional status and quality of life for at least 18 months.
• The Thoratec HeartMate II LVAS demonstrated positive outcomes in bridging patients to cardiac transplantation.