Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Heart Failure Reports
Published in: Current Heart Failure Reports 1/2013

01-03-2013 | Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)

Ventricular Assist Devices: Is Destination Therapy a Viable Alternative in the Non-Transplant Candidate?

Authors: Tara Hrobowski, David E. Lanfear

Published in: Current Heart Failure Reports | Issue 1/2013

Login to get access

Abstract

The topic of this article, stated a more familiar way, is whether left ventricular assist devices (LVADs) are ready for ‘Primetime’ as a therapeutic option in and of themselves. In order to provide an update and insight on this question, we briefly review from where the field has come, and in more detail describe its current state and where we are heading. We believe the short answer to this question is ‘Yes’, but like many things, a short answer is not adequate. Here we attempt to deliver a more comprehensive answer, providing some historical context, outlining the great achievements that have been made, as well as the many challenges that still remain before LVADs become a truly mainstream therapy.
Literature
1.
Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics–2012 update: a report from the american heart association. Circulation. 2012;125:e2–e220.PubMedCrossRef
2.
Stehlik J, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Heart Transplant Report–2011. J Heart Lung Transplant. 2011;30:1078–94.PubMedCrossRef
3.
Institute of Medicine (U.S.), Committee to Evaluate the Artificial Heart Program of the National Heart Lung and Blood Institute, Hogness JR, VanAntwerp M, National Heart Lung and Blood Institute. The artificial heart: prototypes, policies, and patients. Washington, D.C: National Academy Press; 1991.
4.
Levitt JA. Thermo Cardiosystems, Inc.; Premarket approval of the HeartMateRegister IP LVAS. In: Services HaH, ed.: Federal Register, 1996:51712, 51713.
5.
Oz MC, Goldstein DJ, Pepino P, et al. Screening scale predicts patients successfully receiving long-term implantable left ventricular assist devices. Circulation. 1995;92:II169–73.PubMed
6.
Sun BC, Catanese KA, Spanier TB, et al. 100 long-term implantable left ventricular assist devices: the Columbia Presbyterian interim experience. Ann Thorac Surg. 1999;68:688–94.PubMedCrossRef
7.
Di Bella I, Pagani F, Banfi C, et al. Results with the Novacor assist system and evaluation of long-term assistance. Eur J Cardiothorac Surg. 2000;18:112–6.PubMedCrossRef
8.
Rose EA, Moskowitz AJ, Packer M, et al. The REMATCH trial: rationale, design, and end points. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure. Ann Thorac Surg. 1999;67:723–30.PubMedCrossRef
9.
Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345:1435–43.PubMedCrossRef
10.
Rogers JG, Butler J, Lansman SL, et al. Chronic mechanical circulatory support for inotrope-dependent heart failure patients who are not transplant candidates: results of the INTrEPID Trial. J Am Coll Cardiol. 2007;50:741–7.PubMedCrossRef
11.
Jessup M. Mechanical cardiac-support devices–dreams and devilish details. N Engl J Med. 2001;345:1490–3.PubMedCrossRef
12.
Dowling RD, Park SJ, Pagani FD, et al. HeartMate VE LVAS design enhancements and its impact on device reliability. Eur J Cardiothorac Surg. 2004;25:958–63.PubMedCrossRef
13.
Long JW, Kfoury AG, Slaughter MS, et al. Long-term destination therapy with the HeartMate XVE left ventricular assist device: improved outcomes since the REMATCH study. Congest Heart Fail. 2005;11:133–8.PubMedCrossRef
14.
El-Banayosy A, Arusoglu L, Kizner L, et al. Novacor left ventricular assist system versus Heartmate vented electric left ventricular assist system as a long-term mechanical circulatory support device in bridging patients: a prospective study. J Thorac Cardiovasc Surg. 2000;119:581–7.PubMedCrossRef
15.
Thomas CE, Jichici D, Petrucci R, Urrutia VC, Schwartzman RJ. Neurologic complications of the Novacor left ventricular assist device. Ann Thorac Surg. 2001;72:1311–5.PubMedCrossRef
16.
Saito S, Matsumiya G, Ichikawa H, Matsue H, Sekiya N, Sawa Y. Abdominal fascial enlargement to relieve obstruction of the duodenum caused by Novacor left ventricular assist system. J Heart Lung Transplant. 2007;26:759–62.PubMedCrossRef
17.
Samson D. Special report: cost-effectiveness of left-ventricular assist devices as destination therapy for end-stage heart failure. Technol Eval Cent Asses Program Exec Summ 2004;19:1.
18.
Clegg AJ, Scott DA, Loveman E, et al. The clinical and cost-effectiveness of left ventricular assist devices for end-stage heart failure: a systematic review and economic evaluation. Health Technol Assess. 2005;9:1–132. iii-iv.
19.
•• Slaughter MS, Rogers JG, Milano CA, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241–51. Landmark trial demonstrating clearly superior survival and durability of a continous flow LVAD (Heartmate II) compared to the previous destination LVAD.PubMedCrossRef
20.
Salzberg S, Lachat M, Zund G, et al. Left ventricular assist device as bridge to heart transplantation–lessons learned with the MicroMed DeBakey axial blood flow pump. Eur J Cardiothorac Surg. 2003;24:113–8.PubMedCrossRef
21.
Westaby S, Siegenthaler M, Beyersdorf F, et al. Destination therapy with a rotary blood pump and novel power delivery. Eur J Cardiothorac Surg. 2010;37:350–6.PubMed
22.
Esmore D, Kaye D, Spratt P, et al. A prospective, multicenter trial of the VentrAssist left ventricular assist device for bridge to transplant: safety and efficacy. J Heart Lung Transplant. 2008;27:579–88.PubMedCrossRef
23.
Strueber M, O’Driscoll G, Jansz P, Khaghani A, Levy WC, Wieselthaler GM. Multicenter evaluation of an intrapericardial left ventricular assist system. J Am Coll Cardiol. 2011;57:1375–82.PubMedCrossRef
24.
• Aaronson KD, Slaughter MS, Miller LW, et al. Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation. Circulation. 2012;125:3191–200. This multi-center, prospective trial established the HeartWare HVAD in bridge to transplant patients and demonstrated excellent outcomes with over 90 % of patients being alive on device support or transplanted by 6 months.PubMedCrossRef
25.
Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357:885–96.PubMedCrossRef
26.
Fang JC. Rise of the machines–left ventricular assist devices as permanent therapy for advanced heart failure. N Engl J Med. 2009;361:2282–5.PubMedCrossRef
27.
Pagani FD, Miller LW, Russell SD, et al. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol. 2009;54:312–21.PubMedCrossRef
28.
Starling RC, Naka Y, Boyle AJ, et al. Results of the post-U.S. Food and Drug Administration-approval study with a continuous flow left ventricular assist device as a bridge to heart transplantation: a prospective study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). J Am Coll Cardiol. 2011;57:1890–8.PubMedCrossRef
29.
Park SJ, Milano CA, Tatooles AJ, et al. Outcomes in advanced heart failure patients with left ventricular assist devices for destination therapy. Circ Heart Fail. 2012;5:241–8.PubMedCrossRef
30.
Kirklin JK, Naftel DC, Kormos RL, et al. The Fourth INTERMACS Annual Report: 4,000 implants and counting. J Heart Lung Transplant. 2012;31:117–26.PubMedCrossRef
31.
Russell SD, Boyle A, Sun B, et al. Risk of bleeding and stroke in 700 HeartMate II LVAD Outpatients. J Heart Lung Transplant 2011;30(4):Supplement, S66.
32.
Slaughter MS. Hematologic effects of continuous flow left ventricular assist devices. J Cardiovasc Transl Res. 2010;3:618–24.PubMedCrossRef
33.
Swetz KM, Freeman MR, Mueller PS, Park SJ. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant. 2010;29:1081.PubMedCrossRef
34.
Boyle AJ, Russell SD, Teuteberg JJ, et al. Low thromboembolism and pump thrombosis with the HeartMate II left ventricular assist device: analysis of outpatient anti-coagulation. J Heart Lung Transplant. 2009;28:881–7.PubMedCrossRef
35.
John R, Kamdar F, Liao K, et al. Low thromboembolic risk for patients with the Heartmate II left ventricular assist device. J Thorac Cardiovasc Surg. 2008;136:1318–23.PubMedCrossRef
36.
Grady KL, Meyer PM, Dressler D, et al. Longitudinal change in quality of life and impact on survival after left ventricular assist device implantation. Ann Thorac Surg. 2004;77:1321–7.PubMedCrossRef
37.
• Rogers JG, Aaronson KD, Boyle AJ, et al. Continuous flow left ventricular assist device improves functional capacity and quality of life of advanced heart failure patients. J Am Coll Cardiol. 2010;55:1826–34. This was an important work in that it is the largest and most thorough examination of the impact of continuous flow LVADs on quality of life and functional capacity. It demonstrated marked and durable improvements in essentially every measure.PubMedCrossRef
38.
Marcuccilli L, Casida JJ, Peters RM, Wright S. Sex and intimacy among patients with implantable left-ventricular assist devices. J Cardiovasc Nurs. 2011;26:504–11.PubMed
39.
Moskowitz AJ, Rose EA, Gelijns AC. The cost of long-term LVAD implantation. Ann Thorac Surg. 2001;71:S195–8. discussion S203-4.PubMedCrossRef
40.
Slaughter MS, Bostic R, Tong K, Russo M, Rogers JG. Temporal changes in hospital costs for left ventricular assist device implantation. J Card Surg. 2011;26:535–41.PubMedCrossRef
41.
• Rogers JG, Bostic RR, Tong KB, Adamson R, Russo M, Slaughter MS. Cost-effectiveness analysis of continuous-flow left ventricular assist devices as destination therapy. Circ Heart Fail. 2012;5:10–6. This paper is important as it showed the drastically improving cost-effectiveness of LVADs as destination therapy.PubMedCrossRef
42.
Gremeaux V, Troisgros O, Benaim S, et al. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Arch Phys Med Rehabil. 2011;92:611–9.PubMedCrossRef
43.
Majani G, Giardini A, Opasich C, et al. Effect of valsartan on quality of life when added to usual therapy for heart failure: results from the Valsartan Heart Failure Trial. J Card Fail. 2005;11:253–9.PubMedCrossRef
44.
Spertus J, Peterson E, Conard MW, et al. Monitoring clinical changes in patients with heart failure: a comparison of methods. Am Heart J. 2005;150:707–15.PubMedCrossRef
Metadata
Title
Ventricular Assist Devices: Is Destination Therapy a Viable Alternative in the Non-Transplant Candidate?
Authors
Tara Hrobowski
David E. Lanfear
Publication date
01-03-2013
Publisher
Current Science Inc.
Published in
Current Heart Failure Reports / Issue 1/2013
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-012-0123-7

Other articles of this Issue 1/2013

Current Heart Failure Reports 1/2013 Go to the issue

Pharmacologic Therapy (WHW Tang, Section Editor)

Safety and Efficacy of New Anticoagulants in Patients with Heart Failure

Pharmacologic Therapy (WHW Tang, Section Editor)

Novel Vasodilators in Heart Failure

Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)

Impact of Adverse Events on Ventricular Assist Device Outcomes

Pharmacologic Therapy (WHW Tang, Section Editor)

Mineralocorticoid Receptor Antagonism Confers Cardioprotection in Heart Failure

Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)

Stem Cell Therapy: Promising Treatment in Heart Failure?

Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)

Cardiorenal Syndrome and the Role of Ultrafiltration in Heart Failure

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits