Left ventricular assist device (LVAD)

Left ventricular assist device (LVAD)

Left ventricular assist device is used to support the failing left ventricle when it is refractory to guideline directed medical therapy. It can be either a bridge to cardiac transplantation or a destination therapy. In general, cardiac transplantation offers better long term surival compared to LVAD according data available from devices except the most recent.

As per the The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017 [1], there were 126,753 pediatric and adult heart transplants between 1982 and June 2015. Median survival was 10.7 years in adults and 16.1 years in pediatric recipients.

Data published by Evolving Mechanical Support Research Group (EMERG) Investigators [2] in 2018 quotes the median survival among 156 long term survivors between 2005 and 2010 as 7.1 years. It is notable that at 2 years after implantation 97% were in either NYHA (New York Heart Association) functional class I or II. It was 92% at 4 years after implantation of left ventricular assist device.

MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) trial 1- and 2-year survival rates for the HeartMate 3 was published recently [3]. HeartMate 3 is a fully magnetically levitated LVAD. Fully magnetically levitated centrifugal-flow LVAD recepients are less likely to have pump thrombosis or nondisabling stroke than those treated with a mechanical-bearing axial-flow left ventricular assist device at 2 year follow up. Reoperation to replace or remove a malfunctioning device was lower this group. Let us hope that the long term results of the MagLev devices will also be good.

References

1. Lund LH, Khush KK, Cherikh WS, Goldfarb S, Kucheryavaya AY, Levvey BJ, Meiser B, Rossano JW, Chambers DC, Yusen RD, Stehlik J; International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant. 2017 Oct;36(10):1037-1046.
2. Gosev I, Kiernan MS, Eckman P, Soleimani B, Kilic A, Uriel N, Rich JD, Katz JN, Cowger J, Lima B, McGurk S, Brisco-Bacik MA, Lee S, Joseph SM, Patel CB; Evolving Mechanical Support Research Group (EMERG) Investigators. Long-Term Survival in Patients Receiving a Continuous-Flow Left Ventricular Assist Device. Ann Thorac Surg. 2018 Mar;105(3):696-701.
3. Mehra MR, Uriel N, Naka Y, Cleveland JC Jr, Yuzefpolskaya M, Salerno CT, Walsh MN, Milano CA, Patel CB, Hutchins SW, Ransom J, Ewald GA, Itoh A, Raval NY, Silvestry SC, Cogswell R, John R, Bhimaraj A, Bruckner BA, Lowes BD, Um JY, Jeevanandam V, Sayer G, Mangi AA, Molina EJ, Sheikh F, Aaronson K, Pagani FD, Cotts WG, Tatooles AJ, Babu A, Chomsky D, Katz JN, Tessmann PB, Dean D, Krishnamoorthy A, Chuang J, Topuria I, Sood P, Goldstein DJ; MOMENTUM 3 Investigators. A Fully Magnetically Levitated Left Ventricular Assist Device – Final Report. N Engl J Med. 2019 Apr 25;380(17):1618-1627.