Long-term use of a left ventricular assist device for end-stage heart failure

Academic Article

Abstract

  • Background: Implantable left ventricular assist devices have benefited patients with end-stage heart failure as a bridge to cardiac transplantation, but their long-term use for the purpose of enhancing survival and the quality of life has not been evaluated. Methods: We randomly assigned 129 patients with end-stage heart failure who were ineligible for cardiac transplantation to receive a left ventricular assist device (68 patients) or optimal medical management (61). All patients had symptoms of New York Heart Association class IV heart failure. Results: Kaplan-Meier survival analysis showed a reduction of 48 percent in the risk of death from any cause in the group that received left ventricular assist devices as compared with the medical-therapy group (relative risk, 0.52; 95 percent confidence interval, 0.34 to 0.78; P = 0.001). The rates of survival at one year were 52 percent in the device group and 25 percent in the medical-therapy group (P = 0.002), and the rates at two years were 23 percent and 8 percent (P = 0.09), respectively. The frequency of serious adverse events in the device group was 2.35 (95 percent confidence interval, 1.86 to 2.95) times that in the medical-therapy group, with a predominance of infection, bleeding, and malfunction of the device. The quality of life was significantly improved at one year in the device group. Conclusions: The use of a left ventricular assist device in patients with advanced heart failure resulted in a clinically meaningful survival benefit and an improved quality of life. A left ventricular assist device is an acceptable alternative therapy in selected patients who are not candidates for cardiac transplantation. Copyright © 2001 Massachusetts Medical Society.
  • Authors

    Published In

    Digital Object Identifier (doi)

    Pubmed Id

  • 25444619
  • Author List

  • Rose EA; Gelijns AC; Moskowitz AJ; Heitjan DF; Stevenson LW; Dembitsky W; Long JW; Ascheim DD; Tierney AR; Levitan RG
  • Start Page

  • 1435
  • End Page

  • 1443
  • Volume

  • 345
  • Issue

  • 20