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Continuous flow LVADs may serve as permanent therapy for patients with HF
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A recent analysis of INTERMACS data showed that continuous flow left ventricular assist devices may become a permanent treatment option, rather than just a bridge to transplantation, for patients with HF.
Researchers used data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database to compare the durability of implanted pulsatile LVADs with continuous flow LVADs from June 2006 to March 2011. To evaluate durability, they examined data on pump replacement for intractable infection; thrombosis-hemolysis; driveline failure; pump drive unit failure; and death due to driveline or pump drive unit failure.
Researchers excluded paracorporeal pumps and total artificial hearts from analysis, and censored patients from analysis for transplantation, device removal for recovery and death not related to pump failure.
Overall, 3,302 LVADs were implanted (486 pulsatile, 2,816 continuous flow). Researchers found 98 pump exchanges or deaths due to durability issues (46 pulsatile, 52 continuous flow). Twelve months after implant, 54% of patients with continuous flow vs. 23% with pulsatile flow devices were alive and on support.
Patients with continuous flow devices experienced more time to device issues vs. those with pulsatile devices (P<.001). Study results also showed:
- Greater freedom from pump unit failure among continuous flow vs. pulsatile LVADs (P<.0001).
- Similar pump exchange or pump-related deaths for driveline failure between groups (P=.82).
- Similar pump exchange or pump-related death for thrombosis-hemolysis between groups (P=.025).
- Fewer pump exchanges or pump-related deaths for pump infection in continuous flow LVADs (P=.034).
“For some patients, who may have difficulty with transplantation, physicians may soon be able to offer destination therapy as an alternative,” James K. Kirklin, MD, professor and director of the division of cardiothoracic surgery at the University of Alabama at Birmingham, said in a press release. “This has the potential to shorten the transplant waiting lists and offer patients and physicians an alternative option, not just as a bridge to transplant, but as a permanent therapy.”
For more information:
- Holman WL. Abstract #376. Presented at: the International Society for Heart and Lung Transplantation 32nd Annual Meeting and Scientific Sessions; April 18-21, 2012; Prague, Czech Republic.
Disclosure: The researchers report no relevant financial disclosures.