Destination Ventricular Assist Device: A Single-Centre Experience With a Newly Approved Therapy for Advanced Heart...

Destination ventricular assist device (VAD) is a newly approved upfront therapy for advanced heart failure in Australia, presenting a therapeutic option for patients who are unsuitable candidates for cardiac transplantation. This study investigated the mortality and morbidity of patients who underwent VAD implantation for advanced heart failure and subsequently determined destination therapy (DT) in the Australian healthcare context.

We conducted a retrospective analysis of VAD recipients at a statewide advanced heart failure centre between 2012 and 2024. Patient and VAD characteristics, right-sided heart catheter indices, quality of life, and survival outcome data were collected for analysis.

A total of 18 patients were included in the study. The median Interagency Registry for Mechanically Assisted Circulatory Support profile was 2 (interquartile range [IQR] 1.25-3). The median survival from discharge was 5.9 years (IQR 4.1-8.3). Symptoms improved at 6 months (p=0.00016), and Kansas City Heart Failure Questionnaire, EuroQol-5 Dimensions-5 Levels, and Depression in the Medically Ill screening scores improved through to 12 months (p=0.0042, 0.01 and 0.017, respectively) after implantation. The 6-minute walk distance improved from 247.7±149.8 m to 526.9±165.5 m at 12 months after implantation (p=0.003). Right-sided heart catheter indices also improved: mean pulmonary artery pressure (36.6±10.8 to 26.1±14.4 mmHg; p=0.04), pulmonary capillary wedge pressure (25.3±7.6 to 14.1±9.1 mmHg; p=0.02), and cardiac output (3.5±1.3 to 5.5±1.2 L/min; p=0.0005). The median time to confirm DT strategy was 621 days (IQR 314-916); transplant ineligibility was attributed to a range of biopsychosocial factors.

Destination therapy (DT) VAD for advanced heart failure is a feasible therapeutic option for transplant-ineligible patients in Australia, associated with substantial improvements in survival and quality of life. Future studies should focus on optimising remote monitoring and patient selection to further improve long-term outcomes in this complex cohort.