Surgical Management for Heart Failure: A Comparison of Left Ventricular Repair and Ventricular Assist Device

Abstract

Purpose Currently, in Japan, implantable ventricular assist devices (VAD) are limited to bridge to transplantation (BTT). Therefore, left ventricular repair (LVR) has been applied to patients with severe heart failure who were ineligible for cardiac transplantation. We compared the mid-term results of surgical management with LVR and VAD for advanced heart failure. Methods We enrolled 19 patients with advanced heart failure to undergo LVR (n=13) or implantation of VAD (n=6) from 2008 to 2015 in our institute. Procedures in LVR group included papillary muscle approximation in 13 patients, Batista type left ventricular repair in 6, Overlap in 1, and septal anterior ventricular exclusion in 1. The VAD used in this study was HeartMateII (Thoratec, Pleasanton, CA). All patients had symptoms of New York Heart Association class IV but 9 patients class III in LVR group. Results Patients in Group LVR were older than those in Group VAD (Group LVR 63±14 years old vs Group VAD 44±17, p = 0.036). There were no significant differences in preoperative LV EF (Group LVR 21.2±9.1 vs Group VAD 20.3±10.0 %, p = 0.83) or LV end-diastolic dimension (Group LVR 72±13 vs Group VAD 70±12 mm, p = 0.71) between the groups. There was no significant differences in preoperative BNP values (Group LVR 914±500 vs Group VAD 615±241, p = 0.11). Group LVR had 2 in-hospital death after surgery, but VAD had none. There were no significant differences in LV EF (Group LVR 20.2±910.8 vs Group VAD 27.6±19.2 %, p = 0.41) or LV end-diastolic dimension (Group LVR 65±6 vs Group VAD 57±14 mm, p = 0.18) between the groups, immediately after surgery. Follow-up was 2.1±1.8 years long. There were total 10 deaths in Group LVR, but no patients died in Group VAD and 1 patient had transplantation during follow-up. Group VAD had superior 5-year survival rates (Log-rank: Group LVR 9 % vs Group VAD 100 %, p = 0.010.) Conclusion Treatment with VAD in patients with advanced heart failure significantly improved survival compared with LVR. VAD as destination therapy should be warranted in Japan.