Advanced heart failure treated with continuous-flow left ventricular assist device
Open accessAbstract
BACKGROUND: Patients with advanced heart failure have improved survival rates and quality of life when treated with implanted pulsatile-flow left ventricular assist devices as compared with medical therapy. New continuous-flow devices are smaller and may be more durable than the pulsatile-flow devices. METHODS: In this randomized trial, we enrolled patients with advanced heart failure who were ineligible for transplantation, in a 2:1 ratio, to undergo implantation of a continuous-flow device (134 patients) or the currently approved pulsatile-flow device (66 patients). The primary composite end point was, at 2 years, survival free from disabling stroke and reoperation to repair or replace the device. Secondary end points included survival, frequency of adverse events, the quality of life, and functional capacity. RESULTS: Preoperative characteristics were similar in the two treatment groups, with a median age of 64 years (range, 26 to 81), a mean left ventricular ejection fraction of 17%, and nearly 80% of patients receiving intravenous inotropic agents. The primary composite end point was achieved in more patients with continuous-flow devices than with pulsatile-flow devices (62 of 134 [46%] vs. 7 of 66 [11%]; P<0.001; hazard ratio, 0.38; 95% confidence interval, 0.27 to 0.54; P<0.001), and patients with continuous-flow devices had superior actuarial survival rates at 2 years (58% vs. 24%, P=0.008). Adverse events and device replacements were less frequent in patients with the continuous-flow device. The quality of life and functional capacity improved significantly in both groups. CONCLUSIONS: Treatment with a continuous-flow left ventricular assist device in patients with advanced heart failure significantly improved the probability of survival free from stroke and device failure at 2 years as compared with a pulsatile device. Both devices significantly improved the quality of life and functional capacity. (ClinicalTrials.gov number, NCT00121485.)
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Device therapies such as cardiac resynchronization therapy and left ventricular assist devices are associated with reduced dyspnoea.
“Device therapies such as cardiac resynchronization therapy and left ventricular assist devices are also associated with reduced dyspnoea. 58 , 59”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [59]
The Discussion reports improved patient-reported symptom burden after left ventricular assist device implantation and describes symptom improvement in a cited cardiac-resynchronization study. The Functional Status and Quality of Life section also reports improved NYHA class, but neither passage identifies dyspnoea specifically as an outcome that decreased. (LLM, conf=0.83)
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Research works printed but not linked: 1
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“Device therapies such as cardiac resynchronization therapy and left ventricular assist devices are also associated with reduced dyspnoea.(58,59) A greater focus on symptoms could enable promising alternative therapies such as relaxin and sildenafil to explore further which have been yet to be formally approved due to…”
Background
- Authors
- Slaughter, M. S., Rogers, J. G., Milano, C. A., Russell, S. D., Conte, J. V., Feldman, D., Sun, B., Tatooles, A. J., Delgado, R. M., Long, J. W., Wozniak, T. C., Ghumman, W., Farrar, D. J., & Frazier, O. H.
- Affiliations
- Duke Medical Center (US)
- Intermountain Medical Center (US)
- Indiana University Health (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2009-12-03
- Volume
- 361
- Issue
- 23
- Pages
- 2241-2251
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2165719156
- Cited by
- 3,063
- References
- 27
- Citations by year
- 2026: 45 · 2025: 71 · 2024: 78 · 2023: 108 · 2022: 142 · 2021: 163 · 2020: 188 · 2019: 176 · 2018: 205 · 2017: 245 · 2016: 246 · 2015: 235 · 2014: 287 · 2013: 286 · 2012: 262
- FWCI
- 116.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Surgery › Cardiac Structural Anomalies and Repair
- Keywords
- advanced heart failure, continuous-flow LVAD, mechanical circulatory support, survival, stroke, device failure, quality of life, functional capacity, equipment replacement
- MeSH terms
- Actuarial Analysis, Adult, Aged, Aged, 80 and over, Cause of Death, Female, Heart Failure, Heart-Assist Devices, Humans, Male, Middle Aged, Prosthesis Design, Prosthesis Failure, Quality of Life, Stroke Volume, Proportional Hazards Models, Stroke, Kaplan-Meier Estimate
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