Left ventricular assist device for end-stage heart failure: Results of the first LVAD destination program in the Netherlands

Abstract

Purpose Mechanical circulatory support with a continuous-flow left ventricular assist device (LVAD) may be a valuable treatment in end-stage heart failure patients for an extended period of time. The purpose of this study was to evaluate the safety and efficacy of implantation of a continuous-flow LVADin end-stage heart failure patients within the first destination program in the Netherlands. Methods A third-generation LVAD was implanted in 16 heart failure patients (age 61±8; 81%male; left ventricular ejection fraction 20±6%) as destination therapy. All patients were ineligible for heart transplant. At baseline, 3 and 6 months, New York Heart Association (NYHA) functional class, quality-of-life and exercise capacity were assessed. Clinical adverse events were registered. Results Survival at 30 days and 6 months was 88 and 75%, respectively. In the postoperative phase, 6 (38%) patients required continuous veno-venous haemofiltration for renal failure and 2 (13%) patients required extracorporeal membrane oxygenation because of severe right ventricular failure. During follow-up,NYHAfunctional class and quality-of-life improved from 3.7±0.1 to 2.3±0.1 and 57±5 to 23±3 at 6 months (P<0.001), respectively. The 6 min walking distance improved from 168±42 m to 291±29 m at 6 months (P=0.001). Conclusion Continuous-flow LVAD therapy is a promising treatment for patients with end-stage heart failure ineligible for heart transplant.