Left ventricular assist device for end-stage heart failure: results of the first LVAD destination program in the Netherlands

Purpose Mechanical circulatory support with a continuous-flow left ventricular assist device (LVAD) may be a valuable treatment in end-stage heart failure patients for an extended period of time. The purpose of this study was to evaluate the safety and efficacy of implantation of a continuous-flow LVAD in end-stage heart failure patients within the first destination program in the Netherlands. Methods A third-generation LVAD was implanted in 16 heart failure patients (age 61 +/- 8; 81% male; left ventricular ejection fraction 20 +/- 6 %) as destination therapy. All patients were ineligible for heart transplant. At baseline, 3 and 6 months, New York Heart Association (NYHA) functional class, quality-of-life and exercise capacity were assessed. Clinical adverse events were registered. Results Survival at 30 days and 6 months was 88 and 75 %, respectively. In the postoperative phase, 6 (38 %) patients required continuous veno-venous haemofiltration for renal failure and 2 (13 %) patients required extracorporeal membrane oxygenation because of severe right ventricular failure. During follow-up, NYHA functional class and quality-of-life improved from 3.7 +/- 0.1 to 2.3 +/- 0.1 and 57 +/- 5 to 23 +/- 3 at 6 months (P<0.001), respectively. The 6 min walking distance improved from 168 +/- 42 m to 291 +/- 29 m at 6 months (P=0.001). Conclusion Continuous-flow LVAD therapy is a promising treatment for patients with end-stage heart failure ineligible for heart transplant.