Implantable left ventricular assist devices: new hope for patients with end-stage heart failure.
INTRODUCTION: Recently, the Food and Drug Administration approved implantable left ventricular assist devices (LVAD) as destination therapy (DT) for end-stage heart failure patients who are ineligible for cardiac transplantation. OBJECTIVE AND STUDY DESIGN: This is a case series that describes the early results with DT LVAD at Duke University Medical Center (DUMC). An additional objective is to provide general information to a broad group of caregivers on this LVAD therapy, which is a new and developing treatment option. DATA SOURCE/COLLECTION METHODS: Pretreatment clinical condition and outcomes data were collected retrospectively on this cohort of patients through chart review. Outcomes in our patients are compared to data from prior studies and established databases. PRINCIPAL FINDINGS: Since approval of this therapy two years ago, 18 patients have been treated with implantable LVAD as DT at DUMC. The primary reason for ineligibility for transplant was advanced age (median age was 66). Nearly all of the patients (89%) were confined to the hospital requiring continuous inotropic infusions or temporary mechanical support (e.g., intra-aortic balloon pump) prior to LVAD. The 30-day survival following LVAD implantation was 94.5%; one-year survival was 60%. Eighty-nine percent of patients were successfully discharged to independent living. Operative mortality is similar to that of other cardiac surgery procedures performed on patients with advanced heart failure, while duration of intensive care stay and hospitalization remain considerably longer. PRINCIPAL LIMITATIONS: The principal limitation of this review is the absence of a control group of patients with end-stage heart failure who received conventional therapies. For this reason, the DT LVAD outcomes are compared to prior studies and database results. CONCLUSION: Implantable LVAD therapy provides new hope for end-stage heart failure patients who do not qualify for cardiac transplantation.
Milano, CA; Lodge, AJ; Blue, LJ; Smith, PK; Felker, GM; Hernandez, AF; Rosenberg, PB; Rogers, JG
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