636 What Can The Patient With Chronic End-Stage Heart Failure Expect From a Long-Term Left Ventricular Assist Device? A Systematic Review of Current Evidence

Abstract

Cardiac transplantation is the treatment of choice for patients who have end-stage heart failure (HF) but wait times for a suitable donor heart are often long and many patients are ineligible. The continuous-flow left ventricular assist device (LVAD) HeartMate II (HM II) is recognized as an alternative therapeutic option in suitable patients. Patients require clear, evidence-based information on HM II use in order to make an informed decision about this treatment option. To assess the benefits and risks of HM II in patients with chronic end-stage HF (New York Heart Association class IV refractory to optimal medical therapy). A systematic search of scientific literature (2008-2012) identified 6 studies of patients implanted with HM II as “bridge to transplant” (BTT; transplant-eligible patients) and 4 studies of patients implanted with HM II as “destination therapy” (DT; transplant-ineligible patients). Study selection, data extraction and quality assessment were done by two independent reviewers. A synthesis of the data was discussed with clinicians specialized in the LVAD domain. BTT patients have a >75% chance of 1-year survival; DT patients have a >70% chance of 1-year survival. Six months after LVAD implantation, >80% of both groups of patients are able to perform activities of daily living with no or only mild HF symptoms, and patients can walk an average of 325 metres in 6 minutes. Both groups of patients can expect no deterioration of neurocognitive function while on support; for BTT patients, renal/liver function may improve. Patients should expect to spend 3 weeks in hospital for the LVAD implantation. While on support, there is a significant risk of various serious complications, as summarized in the Table. Most complications occur in the first 30 days (particularly bleeding requiring surgery); afterwards, the most likely complication is infection. Patients must accept long-term lifestyle adaptation and meticulous device care, and will require the continuous support of family/friends and formal caregivers.Tabled 1 A systematic literature review that examines all aspects of LVAD use and is interpreted from the patient's perspective can be used to support decision-making that is both patient-centred and evidence-based. Because current data is relatively limited (especially with respect to perceived quality of life) and level of evidence is generally weak, this approach promises to become increasingly informative as more experience becomes available.