Abstract 3662: Transformation of LVAD Destination Therapy, “Good to Great”: Ever Increasing Survival Benefit
Background: LVAD therapy in REMATCH increased survival more than two fold over optimal medical management (OMM), but the 2 year survival rate was still disappointing at 25%. We hypothesized that more current outcomes with destination therapy (DT) would be much improved. We reviewed our most recent 2 year experience.
Methods: Patients’ baseline characteristics, hospital course during index LVAD implantation and subsequent readmissions, NYHA class and survival outcomes were compared.
Results: Of 31 patients in our current cohort (CC) of LVAD recipients as destination therapy, most (88%) received axial flow pumps. Baseline characteristics were comparable between CC and REMATCH reflecing end-stage heart failure. We noted a striking improvement in early survival with following LVAD implantation over the REMATCH surgical cohort (figure 1⇓). Subsequently, the attrition rate was negligible in CC while it continued in REMATCH. At two years, survival post LVAD was 74% in CC vs. 23% in REMATCH. Median index hospital stay was 21 days in CC as compared to 29 days in REMATCH. The total fraction of follow-up time in hospital was significantly less in CC (6.9%, 22 of 315 days) compared to REMATCH surgical cohort (21.6%, 88 of 408 days). NYHA functional class was reduced from IV to II both in CC and REMATCH surgical cohort.
Conclusions: Our recent LVAD DT outcomes are dramatically improved compared to the historically reported REMATCH trial results. Patients with endstage heart failure now should be able to expect about 75% survival at two years with minimal need for re-hospitalization. LVAD DT therapy is rapidly transforming into an excellent longterm strategy for patients with endstage heart failure.