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Destination Therapy with Left Ventricular Assist Devices in Non-transplant Centres: The Time is Right

Antoni Bayes-Genis1,2, Christian Muñoz-Guijosa1,2, Evelyn Santiago-Vacas1,2

  • 1Heart Institute, Hospital Universitari Germans Trias i Pujol Badalona, Spain.

European Cardiology
|May 19, 2020
PubMed

Insights

Implantable left ventricular assist devices (LVADs) offer a viable alternative to heart transplant for end-stage heart failure. Outcomes for LVAD destination therapy (LVAD-DT) are comparable to transplant, even in non-transplant centers.

Area of Science:

  • Cardiology
  • Mechanical Circulatory Support
  • Heart Failure Management

Background:

  • Cardiac transplant has been the sole long-term treatment for end-stage heart failure for decades.
  • Implantable left ventricular assist devices (LVADs) are emerging as a crucial treatment for advanced heart failure.
  • LVADs serve as destination therapy for patients ineligible for transplant due to age or other conditions.

Purpose of the Study:

  • To compare the efficacy of LVAD destination therapy (LVAD-DT) against cardiac transplant.
  • To evaluate the feasibility of LVAD-DT in non-transplant centers.

Main Methods:

  • Meta-analysis of head-to-head comparisons between cardiac transplant and LVAD-DT.
  • Subanalysis of data from the Interagency Registry for Mechanically Assisted Circulatory Support.

Main Results:

  • No significant difference in 1-year mortality rates between LVAD-DT and cardiac transplant (OR 1.49; 95% CI [0.48-4.66]).
  • Similar patient outcomes observed following LVAD-DT implantation in both transplant and non-transplant centers.

Conclusions:

  • LVAD-DT presents a comparable alternative to cardiac transplant for end-stage heart failure.
  • LVAD-DT is suitable for implementation in non-transplant centers, contingent upon established multidisciplinary heart failure teams and expertise.

Keywords:
Cardiac transplantdestination therapyleft ventricular assist deviceoutcomes

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