Cardiac transplantation is the gold standard treatment for patients with end-stage heart failure. Unfortunately, the demand for donor organs far outstrips the number of available hearts. Therefore, not all patients who can benefit from this therapy are even listed for transplant. Once destination therapy was approved for the long-term support of nontransplant eligible patients, it was felt that the number of durable ventricular assist device (VAD) implants would increase. It was not until the current generation continuous-flow VADs became available that the number of DT-VAD implants grew significantly. The purpose of this manuscript is to review current indications and outcomes following durable VAD implant for destination therapy.
In 2014, DT-VADs accounted for 46% of all implants. A propensity-matched analysis showed that 1-year and 2-year survival rates were similar between LVADs and cardiac transplantation. Likely because of their younger age and lack of comorbidities, survival after VAD implant in transplant eligible patients remains higher than after DT-VAD implant. However, the survival differences are narrowing. Although the rates of LVAD-related adverse events continue to be high, studies such as the PREVENT trial have proven that strict adherence to management protocols can reduce event rates.
Improvements in device technology as well as patient selection and management have led to improved medium term (2–4 years) survival after VAD implant in nontransplant eligible patients. We anticipate that this technology will soon be a reasonable and competitive alternative to conventional heart transplantation.
Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Correspondence to Vivek Rao, MD, PhD, FRCS, FAHA, Chief, Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, ONT M5G 2C4, Canada. Tel: +1 416 340 3562; fax: +1 416 340 3337; e-mail: firstname.lastname@example.org