Destination Therapy with Left Ventricular Assist Devices in Non-transplant Centres: The Time is Right

Antoni Bayes-Genis; Christian Muñoz-Guijosa; Evelyn Santiago-Vacas; Santiago Montero; Cosme García-García; Pau Codina; Julio Núñez; Josep Lupón

doi:10.15420/ecr.2019.29.2

Destination Therapy with Left Ventricular Assist Devices in Non-transplant Centres: The Time is Right

Eur Cardiol. 2020 Apr 27:15:e19. doi: 10.15420/ecr.2019.29.2. eCollection 2020 Feb.

Authors

Antoni Bayes-Genis^{1

2}, Christian Muñoz-Guijosa^{1

2}, Evelyn Santiago-Vacas^{1

2}, Santiago Montero^{1

2}, Cosme García-García^{1

2}, Pau Codina^{1

2}, Julio Núñez³, Josep Lupón^{1

2}

Affiliations

¹ Heart Institute, Hospital Universitari Germans Trias i Pujol Badalona, Spain.
² Department of Medicine, CIBERCV, Autonomous University of Barcelona Barcelona, Spain.
³ Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVA Valencia, Spain.

Abstract

For almost half a century, cardiac transplant has been the only long-term treatment for patients with end-stage heart failure. Implantable left ventricular assist devices (LVADs) have emerged as a new treatment option for advanced heart failure as destination therapy for patients either too old or not suitable for transplant. A meta-analysis presenting head-to-head comparisons of cardiac transplant versus LVAD as destination therapy (LVAD-DT) found no difference in 1-year mortality rates between LVAD-DT and cardiac transplant (OR 1.49; 95% CI [0.48-4.66]; I2=82.8%). Moreover, a recent subanalysis from the Interagency Registry for Mechanically Assisted Circulatory Support found similar outcomes after LVAD-DT implantation in both transplant and non-transplant centres. The time is right for LVAD-DT in non-transplant centres, provided multidisciplinary heart failure teams and expertise are in place.

Keywords: Cardiac transplant; destination therapy; left ventricular assist device; outcomes.

Publication types

Review