1932

Abstract

The number of patients with end-stage heart failure (HF) continues to increase over time, but there has been little change in the availability of organs for cardiac transplantation, intensifying the demand for left ventricular assist devices (LVADs) as a bridge to transplantation. There is also a growing number of patients with end-stage HF who are not transplant candidates but may be eligible for long-term support with an LVAD, known as destination therapy. Due to this increasing demand, LVAD technology has evolved, resulting in transformative improvements in outcomes. Additionally, with growing clinical experience patient management continues to be refined, leading to iterative improvements in outcomes. With outcomes continuing to improve, the potential benefit from LVAD therapy is being considered for patients earlier in their course of advanced HF. We review recent changes in technology, patient management, and implant decision making in LVAD therapy.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-med-041217-011015
2019-01-27
2024-12-02
Loading full text...

Full text loading...

/deliver/fulltext/med/70/1/annurev-med-041217-011015.html?itemId=/content/journals/10.1146/annurev-med-041217-011015&mimeType=html&fmt=ahah

Literature Cited

  1. 1.  Hunt SA, Abraham WT, Chin MH, et al. 2005. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J. Am. Coll. Cardiol. 46:e1–82
    [Google Scholar]
  2. 2.  Massie BM, Shah NB 1997. Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am. Heart J. 133:703–12
    [Google Scholar]
  3. 3.  Cleland JG, Gemmell I, Khand A et al. 1999. Is the prognosis of heart failure improving?. Eur. J. Heart Fail. 1:229–41
    [Google Scholar]
  4. 4.  Kittleson MM, Kobashigawa JA 2017. Cardiac transplantation: current outcomes and contemporary controversies. JACC Heart Fail 5:857–68
    [Google Scholar]
  5. 5.  Hsich EM 2016. Matching the market for heart transplantation. Circ. Heart Fail. 9:e002679
    [Google Scholar]
  6. 6.  Khush KK, Zaroff JG, Nguyen J et al. 2015. National decline in donor heart utilization with regional variability: 1995–2010. Am. J. Transplant. 15:642–49
    [Google Scholar]
  7. 7.  Kirklin JK, Pagani FD, Kormos RL et al. 2017. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J. Heart Lung Transplant. 36:1080–86
    [Google Scholar]
  8. 8.  Teuteberg JJ, Stewart GC, Jessup M et al. 2013. Implant strategies change over time and impact outcomes: insights from the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). JACC Heart Fail 1:369–78
    [Google Scholar]
  9. 9.  Cook JL, Colvin M, Francis GS et al. 2017. Recommendations for the use of mechanical circulatory support: ambulatory and community patient care. A scientific statement from the American Heart Association. Circulation 135:1145–58
    [Google Scholar]
  10. 10.  Stewart GC, Kittleson MM, Patel PC et al. 2016. INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiling identified ambulatory patients at high risk on medical therapy after hospitalizations for heart failure. Circ. Heart Fail. 9:e003032
    [Google Scholar]
  11. 11.  Patel SR, Saeed O, Naftel D et al. 2017. Outcomes of restrictive and hypertrophic cardiomyopathies after LVAD: an INTERMACS analysis. J. Card. Fail. 23:859–67
    [Google Scholar]
  12. 12.  Lampert BC, Teuteberg JJ 2015. Right ventricular failure after left ventricular assist devices. J. Heart Lung Transplant. 34:1123–30
    [Google Scholar]
  13. 13.  Soliman OI, Akin S, Muslem R 2017. Derivation and validation of a novel right-sided heart failure model after implantation of continuous flow left ventricular assist devices: the EUROMACS right-sided heart failure score. Circulation 137:891–906
    [Google Scholar]
  14. 14.  Matthews JC, Pagani FD, Haft JW et al. 2010. MELD score predicts LVAD operative transfusion requirements, morbidity, and mortality. Circulation 121:214–20
    [Google Scholar]
  15. 15.  Rose EA, Gelijns AC, Moskowitz AJ et al. 2001. Long-term use of a left ventricular assist device for end-stage heart failure. N. Engl. J. Med. 345:1435–43
    [Google Scholar]
  16. 16.  Miller LW, Pagani FD, Russell SD et al. 2007. Use of a continuous-flow device in patients awaiting heart transplantation. N. Engl. J. Med. 357:885–96
    [Google Scholar]
  17. 17.  Aaronson KD, Slaughter MS, Miller LW et al. 2012. Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation. Circulation 125:3191–200
    [Google Scholar]
  18. 18.  Schmitto JD, Hanke JS, Rojas SV et al. 2015. First implantation in man of a new magnetically levitated left ventricular assist device (HeartMate III). J. Heart Lung Transplant. 34:858–60
    [Google Scholar]
  19. 19.  Heatley G, Sood P, Goldstein D et al. 2016. Clinical trial design and rationale of the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3) investigational device exemption clinical study protocol. J. Heart Lung Transplant. 35:528–36
    [Google Scholar]
  20. 20.  Rose EA, Levin HR, Oz MC et al. 1994. Artificial circulatory support with textured interior surfaces. A counterintuitive approach to minimizing thromboembolism. Circulation 90:II87–91
    [Google Scholar]
  21. 21.  Crow S, John R, Boyle A et al. 2009. Gastrointestinal bleeding rates in recipients of nonpulsatile and pulsatile left ventricular assist devices. J. Thorac. Cardiovasc. Surg. 137:208–15
    [Google Scholar]
  22. 22.  Mehra MR, Naka Y, Uriel N et al. 2017. A fully magnetically levitated circulatory pump for advanced heart failure. N. Engl. J. Med. 376:440–50
    [Google Scholar]
  23. 23.  Goldstein DJ, Mehra MR, Naka Y et al. 2018. Impact of age, sex, therapeutic intent, race and severity of advanced heart failure on short-term principal outcomes in the MOMENTUM 3 trial. J. Heart Lung Transplant. 37:7–14
    [Google Scholar]
  24. 24.  Uriel N, Colombo PC, Cleveland JC et al. 2017. Hemocompatibility-related outcomes in the MOMENTUM 3 trial at 6 months: a randomized controlled study of a fully magnetically levitated pump in advanced heart failure. Circulation 135:2003–12
    [Google Scholar]
  25. 25.  Netuka I, Mehra MR 2018. Ischemic stroke and subsequent thrombosis within a HeartMate 3 left ventricular assist system: a cautionary tale. J. Heart Lung Transplant. 37:170–72
    [Google Scholar]
  26. 26.  Klotz S, Karluss A, Stock S et al. 2017. HeartMate III left ventricular assist device thrombosis triggered by an automatic implantable cardioverter-defibrillator shock. Ann. Thorac. Surg. 104:e421–24
    [Google Scholar]
  27. 27.  Mehra MR, Goldstein DJ, Uriel N et al. 2018. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N. Engl. J. Med. 378:1386–95
    [Google Scholar]
  28. 28.  Posada JG, Moayedi Y, Alhussein M 2017. Outflow graft occlusion of the HeartMate 3 left ventricular assist device. Circ. Heart Fail. 10:e004275
    [Google Scholar]
  29. 29.  Latrémouille C, Carpentier A, Leprince P et al. 2018. A bioprosthetic total artificial heart for end-stage heart failure: results from a pilot study. J. Heart Lung Transplant. 37:33–37
    [Google Scholar]
  30. 30.  Leuck AM 2015. Left ventricular assist device driveline infections: recent advances and future goals. J. Thorac. Dis. 7:2151–57
    [Google Scholar]
  31. 31.  Al-Banayosy A, Arusoglu L, Kizner L et al. 2003. Preliminary experience with the LionHeart left ventricular assist device in patients with end-stage heart failure. Ann. Thorac. Surg. 75:1469–75
    [Google Scholar]
  32. 32.  Rogers JG, Pagani FD, Tatooles AJ et al. 2017. Intrapericardial left ventricular assist device for advanced heart failure. N. Engl. J. Med. 376:451–60
    [Google Scholar]
  33. 33.  Kirklin JK, Naftel DC, Kormos RL et al. 2014. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device. J. Heart Lung Transplant. 33:12–22
    [Google Scholar]
  34. 34.  Starling RC, Moazami N, Silvestry SC et al. 2013. Unexpected abrupt increase in left ventricular assist device thrombosis. N. Engl. J. Med. 370:33–40
    [Google Scholar]
  35. 35.  Stulak JM, Maltais S 2014. A different perspective on thrombosis and the HeartMate II. N. Engl. J. Med. 370:1467–68
    [Google Scholar]
  36. 36.  Maltais S, Kilic A, Nathan S et al. 2017. PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management: the PREVENT multi-center study. J. Heart Lung Transplant. 36:1–12
    [Google Scholar]
  37. 37.  Cowger JA, Rogers JG, Milano CA et al. 2017. The effects of patient blood pressure on the occurrence of serious adverse events in the ENDURANCE trial. J. Heart Lung Transplant. 36:S193–94
    [Google Scholar]
  38. 38.  Bennett MK, Adatya S 2015. Blood pressure management in mechanical circulatory support. J. Thorac. Dis. 7:2125–28
    [Google Scholar]
  39. 39.  Milano CA, Rogers JG, Tatooles AJ et al. 2017. The treatment of patients with advanced heart failure ineligible for cardiac transplantation with the HeartWare ventricular assist device: results of the ENDURANCE supplement trial. J. Heart Lung Transplant. 36:S10
    [Google Scholar]
  40. 40.  Stulak JM, Sharma S, Maltais S 2015. Management of pump thrombosis in patients with left ventricular assist devices. Am. J. Cardiovasc. Drugs 15:89–94
    [Google Scholar]
  41. 41.  Kilic A, Acker MA, Atluri P 2015. Dealing with surgical left ventricular assist device complications. J. Thorac. Dis. 7:2158–64
    [Google Scholar]
  42. 42.  Jorde UP, Aaronson KD, Najjar SS et al. 2015. Identification and management of pump thrombus in the HeartWare left ventricular assist device system: a novel approach using log file analysis. JACC Heart Fail 3:849–56
    [Google Scholar]
  43. 43.  Slaughter MS, Rogers JG, Milano CA et al. 2009. Advanced heart failure treated with continuous-flow left ventricular assist device. N. Engl. J. Med. 361:2241–51
    [Google Scholar]
  44. 44.  Ledford ID, Miller DV, Mason NO et al. 2011. Differential infection rates between velour versus silicone interface at the HeartMate II driveline exit site: structural and ultrastructural insight into possible causes. J. Heart Lung Transplant. 30:S10–11
    [Google Scholar]
  45. 45.  Dean D, Kallel F, Ewald GA et al. 2015. Reduction in driveline infection rates: results from the HeartMate II Multicenter Driveline Silicone Skin Interface (SSI) Registry. J. Heart Lung Transplant. 34:781–89
    [Google Scholar]
  46. 46.  Danter MR, McGee EC, Strueber M et al. 2017. A prospective, controlled, un-blinded, multi-center clinical trial to evaluate the thoracotomy implant technique of the HVAD system in patients with advanced heart failure: results of the LATERAL trial. J. Heart Lung Transplant. 36:S66
    [Google Scholar]
  47. 47.  Chew DS, Manns B, Miller RJH et al. 2017. Economic evaluation of left ventricular assist devices for patients with end stage heart failure who are ineligible for cardiac transplantation. Can. J. Cardiol. 33:1283–91
    [Google Scholar]
  48. 48.  Starling RC, Estep JD, Horstmanshof DA et al. 2017. Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: the ROADMAP study 2-year results. JACC Heart Fail 5:518–27
    [Google Scholar]
  49. 49.  Baldwin JT, Mann DL 2010. NHLBI's program for VAD therapy for moderately advanced heart failure: the REVIVE-IT pilot trial. J. Cardiac Fail. 16:855–58
    [Google Scholar]
  50. 50.  Pagani FD, Aaronson KD, Kormos R et al. 2016. The NHLBI REVIVE-IT study: understanding its discontinuation in the context of current left ventricular assist device therapy. J. Heart Lung Transplant. 35:1277–83
    [Google Scholar]
  51. 51.  Sayer G, Anderson A, Raichlin E et al. 2018. Heart failure clinicians want to revive the REVIVE-IT study following the results of the MOMENTUM 3 and ENDURANCE supplement trials. J. Heart Lung Transplant. 37:S466
    [Google Scholar]
  52. 52.  Ambardekar V, Kittleson M, Palardy M et al. 2017. Advanced therapy utilization and survival in ambulatory patients with advanced heart failure: results from the Medical Arm of Mechanically Assisted Circulatory Support (MedaMACS) Registry. J. Heart Lung Transplant. 36:S193
    [Google Scholar]
  53. 53.  Ambardekar AV, Forde-McLean RC, Kittleson MM et al. 2016. High early event rates in patients with questionable eligibility for advanced heart failure therapies: results from the Medical Arm of Mechanically Assisted Circulatory Support (Medamacs) Registry. J. Heart Lung Transplant. 35:722–30
    [Google Scholar]
  54. 54.  Stehlik J, Estep JD, Selzman CH et al. 2017. Patient-reported health-related quality of life is a predictor of outcomes in ambulatory heart failure patients treated with left ventricular assist device compared with medical management: results from the ROADMAP study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management). Circ. Heart Fail. 10:e003910
    [Google Scholar]
  55. 55.  Cowger J, Shah P, Stulak J et al. 2016. INTERMACS profiles and modifiers: heterogeneity of patient classification and the impact of modifiers on predicting patient outcome. J. Heart Lung Transplant. 35:440–48
    [Google Scholar]
  56. 56.  Allen LA, McIlvennan CK, Thompson JS et al. 2018. Effectiveness of an intervention supporting shared decision making for destination therapy left ventricular assist device: the DECIDE-LVAD randomized clinical trial. JAMA Intern. Med. 178:520–29
    [Google Scholar]
/content/journals/10.1146/annurev-med-041217-011015
Loading
/content/journals/10.1146/annurev-med-041217-011015
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error