Left ventricular assist devices as destination therapy: A new look at survival

Soon J. Park, Alfred Tector, William Piccioni, Edward Raines, Annetine Gelijns, Alan Moskowitz, Eric Rose, William Holman, Satoshi Furukawa, O. Howard Frazier, Walter Dembitsky

Research output: Contribution to journalArticle

215 Scopus citations

Abstract

The REMATCH trial compared the use of left ventricular assist devices with optimal medical management for patients with end-stage heart failure. When the trial met its primary end point criteria in July 2001, left ventricular assist device therapy was shown to significantly improve survival and quality of life. With extended follow-up, 2 critical questions emerge: (1) Did these benefits persist, and (2) did outcomes improve over the course of the trial, given the evolving nature of the technology? We analyzed survival in this randomized trial by using the product-limit method of Kaplan and Meier. Changes in the benefits of therapy were analyzed by examining the effect of the enrollment period. The survival rates for patients receiving left ventricular assist devices (n = 68) versus patients receiving optimal medical management (n = 61) were 52% versus 28% at 1 year and 29% versus 13% at 2 years (P =. 008, log-rank test). As of July 2003, 11 patients were alive on left ventricular assist device support out of a total 16 survivors (including 3 patients receiving optimal medical management who crossed over to left ventricular assist device therapy). There was a significant improvement in survival for left ventricular assist devicesupported patients who enrolled during the second half of the trial compared with the first half (P =. 03). The Minnesota Living with Heart Failure scores improved significantly over the course of the trial. The extended follow-up confirms the initial observation that left ventricular assist device therapy renders significant survival and quality-of-life benefits compared with optimal medical management for patients with end-stage heart failure. Furthermore, we observed an improvement in the survival of patients receiving left ventricular assist devices over the course of the trial, suggesting the effect of greater clinical experience.

Original languageEnglish (US)
Pages (from-to)9-17
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume129
Issue number1
DOIs
StatePublished - Jan 2005

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Park, S. J., Tector, A., Piccioni, W., Raines, E., Gelijns, A., Moskowitz, A., Rose, E., Holman, W., Furukawa, S., Frazier, O. H., & Dembitsky, W. (2005). Left ventricular assist devices as destination therapy: A new look at survival. Journal of Thoracic and Cardiovascular Surgery, 129(1), 9-17. https://doi.org/10.1016/j.jtcvs.2004.04.044