Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection

Life · 12 authors, 6 centres

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TL;DR

This narrative review summarizes evidence on LVAD as destination therapy for advanced heart failure patients ineligible for transplantation, highlighting improved survival and quality of life with modern devices.

Full summary

404 CHARS

Third-generation fully magnetically levitated devices have achieved 1-year survival of 83% and 5-year survival exceeding 50%, with two-year survival above 70%. Quality of life improvements were demonstrated, with 85% of patients in the INTrEPID trial becoming asymptomatic or minimally symptomatic at one year, and improved functional status in the ROADMAP study with LVAD versus optimal medical therapy.

STUDY TYPE

narrative_review

SPECIALTY

cardiology

SUMMARISED BY

AI pipeline

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100% · A

ORIGINAL PAPER

PMC10144236

Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection

Life

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ABSTRACT

Abstract Advanced heart failure is a growing problem for which the best treatment is cardiac transplantation. However, the shortage of donors’ hearts made left ventricular assist devices as destination therapy (DT-LVAD) a highly recommended alternative: they improved mid-term prognosis as well as patients’ quality of life. Current intracorporeal pumps with a centrifugal continuous flow evolved in the last few years. Since 2003, when first LVAD was approved for long-term support, smaller device sizes with better survival and hemocompatibility profile were reached. The most important difficulty lies in the moment of the implant. Recent indications range from INTERMACS class 2 to 4, with close monitoring in intermediate cases. Moreover, a large multiparametric study is needed for considering the candidacy: basal situation, with a special interest in frailty, comorbidities, including renal and hepatic dysfunction, and medical background, considering every prior cardiac condition, must be evaluated. In addition, some clinical risk scores can be helpful to measure the possibility of right heart failure or morbi-mortality. With this review, we sought to summarize all the device improvements, with their updated clinical results, as well as to focus on all the patient selection criteria. Keywords: left ventricular assist device, destination therapy, patient selection, frailty, comorbidities, right ventricular disfunction

CITATION EXPORT

María Melendo-Viu, David Dobarro, Sergio Raposeiras Roubin et al.. Left Ventricular Assist Device as a Destination Therapy: Current Situation and the Importance of Patient Selection. Life. (2023). https://doi.org/10.3390/life13041065

AUTHORS

12 · 6 CENTRES

María Melendo-Viu, David Dobarro, Sergio Raposeiras Roubin, Carmen Llamas Pernas, Candela Moliz Cordón, Miriam Vazquez Lamas, Miguel Piñón Esteban, Maria Ángela Varela Martínez, Emad Abu Assi, Rafael Pita Romero, Juan José Legarra Calderón, Andrés Íñiguez Romo

1Cardiology Department, University Hospital Álvaro Cunqueiro, 36213 Vigo, Spain
2Health Research Institute Galicia Sur, 36312 Vigo, Spain
3Faculty of Medicine, University Complutense of Madrid, 28040 Madrid, Spain
4Anaesthesiology Department, University Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
5Nephrology Department, Regional University Hospital of Málaga, 29010 Málaga, Spain
6Cardiovascular Surgery, University Hospital Álvaro Cunqueiro, 36312 Vigo, Spain