Long-term use of a left ventricular assist device for end-stage heart failure

Eric A. Rose, Annetine C. Gelijns, Alan J. Moskowitz, Daniel F. Heitjan, Lynne W. Stevenson, Walter Dembitsky, James W. Long, Deborah D. Ascheim, Anita R. Tierney, Ronald G. Levitan, John T. Watson, Nuala S. Ronan, Peter A. Shapiro, Ronald M. Lazar, Leslie W. Miller, Lopa Gupta, Patrice Desvigne-Nickens, Paul Meier, O. Howard Frazier, Patrice Desvigne-NickensMehmet C. Oz, Victor L. Poirier

Research output: Contribution to journalArticle

2899 Scopus citations

Abstract

Background: Implantable left ventricular assist devices have benefited patients with end-stage heart failure as a bridge to cardiac transplantation, but their long-term use for the purpose of enhancing survival and the quality of life has not been evaluated. Methods: We randomly assigned 129 patients with end-stage heart failure who were ineligible for cardiac transplantation to receive a left ventricular assist device (68 patients) or optimal medical management (61). All patients had symptoms of New York Heart Association class IV heart failure. Results: Kaplan-Meier survival analysis showed a reduction of 48 percent in the risk of death from any cause in the group that received left ventricular assist devices as compared with the medical-therapy group (relative risk, 0.52; 95 percent confidence interval, 0.34 to 0.78; P = 0.001). The rates of survival at one year were 52 percent in the device group and 25 percent in the medical-therapy group (P = 0.002), and the rates at two years were 23 percent and 8 percent (P = 0.09), respectively. The frequency of serious adverse events in the device group was 2.35 (95 percent confidence interval, 1.86 to 2.95) times that in the medical-therapy group, with a predominance of infection, bleeding, and malfunction of the device. The quality of life was significantly improved at one year in the device group. Conclusions: The use of a left ventricular assist device in patients with advanced heart failure resulted in a clinically meaningful survival benefit and an improved quality of life. A left ventricular assist device is an acceptable alternative therapy in selected patients who are not candidates for cardiac transplantation.

Original languageEnglish (US)
Pages (from-to)1435-1443
Number of pages9
JournalNew England Journal of Medicine
Volume345
Issue number20
DOIs
StatePublished - Nov 15 2001

    Fingerprint

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rose, E. A., Gelijns, A. C., Moskowitz, A. J., Heitjan, D. F., Stevenson, L. W., Dembitsky, W., Long, J. W., Ascheim, D. D., Tierney, A. R., Levitan, R. G., Watson, J. T., Ronan, N. S., Shapiro, P. A., Lazar, R. M., Miller, L. W., Gupta, L., Desvigne-Nickens, P., Meier, P., Howard Frazier, O., ... Poirier, V. L. (2001). Long-term use of a left ventricular assist device for end-stage heart failure. New England Journal of Medicine, 345(20), 1435-1443. https://doi.org/10.1056/NEJMoa012175