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Published on: August 16, 2021
Clinical outcomes after continuous-flow left ventricular assist device: a systematic review
Colleen K McIlvennan1, Kate H Magid2, Amrut V Ambardekar2
1From the Division of Cardiology (C.K.M., A.V.A., L.A.A.), Adult and Child Center for Health Outcomes Research and Delivery Science (K.H.M., J.S.T.), and Division of General Internal Medicine (D.D.M.), University of Colorado School of Medicine, Aurora; Brown University, School of Public Health, Providence, RI (K.H.M.); and Colorado Cardiovascular Outcomes Research Consortium, Denver (C.K.M., D.D.M., L.A.A.). colleen.mcilvennan@ucdenver.edu.
Continuous-flow left ventricular assist devices improve survival and quality of life but carry significant risks. This summary aids healthcare providers in discussing these complex trade-offs with patients.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Outcomes
Background:
- Summarizing outcomes for continuous-flow left ventricular assist devices (CF-LVADs) is challenging due to complex trade-offs.
- An evidence summary for the full range of CF-LVAD outcomes is currently lacking.
Purpose of the Study:
- To summarize current evidence on the outcomes of continuous-flow left ventricular assist devices.
- To provide a practical resource for healthcare providers discussing CF-LVADs with patients.
Main Methods:
- Searched PubMed and Cochrane Library (Jan 2007-Dec 2013), supplemented by manual review.
- Three reviewers assessed study saliency on patient-centered outcomes; data were summarized in tabular form.
- Included studies covered all indications (destination therapy and bridge to transplant), preventing meta-analysis.
Main Results:
- Actuarial survival ranged from 56-87% at 1 year, 43-84% at 2 years, and 47% at 4 years.
- Improvements in functional class and quality of life were reported, though data limitations complicated interpretation.
- Most patients experienced adverse events, with wide variations in estimates for bleeding, stroke, infection, right heart failure, arrhythmias, and rehospitalizations.
Conclusions:
- Continuous-flow left ventricular assist devices demonstrate consistent improvements in survival and quality of life.
- These benefits are counterbalanced by a range of common complications.
- Highlights the critical need for high-quality, patient-centered data collected with standard definitions.
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