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Left ventricular assist device as destination therapy for end stage heart failure: the right time for the right

Naoto Fukunaga1, Vivek Rao

  • 1Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

Current Opinion in Cardiology
|January 11, 2018
PubMed

Insights

Destination therapy with ventricular assist devices (VADs) is becoming a viable alternative to heart transplantation. Improved VAD technology and patient management are narrowing survival gaps for end-stage heart failure patients.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac transplantation is the optimal treatment for end-stage heart failure, but organ availability is limited.
  • Destination therapy (DT) using durable ventricular assist devices (VADs) offers an alternative for patients ineligible for transplantation.
  • The advent of continuous-flow VADs has significantly increased DT-VAD implantations.

Purpose of the Study:

  • To review current indications for durable VAD implantation for destination therapy.
  • To summarize outcomes following durable VAD implantation for destination therapy.

Main Methods:

  • Review of current literature on destination therapy VADs.
  • Analysis of outcomes including survival rates and adverse events.
  • Comparison of DT-VADs with cardiac transplantation.

Main Results:

  • In 2014, DT-VADs represented 46% of all VAD implants.
  • One- and 2-year survival rates for DT-VADs are comparable to cardiac transplantation.
  • Survival differences between VADs in transplant-eligible versus DT patients are narrowing.
  • Adherence to management protocols can reduce VAD-related adverse events.

Conclusions:

  • Advancements in VAD technology, patient selection, and management have improved outcomes for non-transplant-eligible patients.
  • DT-VADs are emerging as a competitive alternative to traditional heart transplantation.
  • Continued improvements are expected to further enhance the role of VADs in heart failure management.
Abstract

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