Are LVAD Support and Cardiac Transplantation Approaching Equipoise?

IntroductionCardiac transplantation (Tx) is the standard of care for terminal heart failure although limited donor availability, recipient selection restrictions and complications related to immunosuppression have made its impact epidemiologically trivial. The utility of LVAD support has been limited by poor survival, device complications and expense. Recently however, outcomes with the HeartMate II (HMII) have approached those of Tx making direct comparisons timely.MethodsAll patients having a HMII implant (102) or Tx (59) at a single institution since 2006 were reviewed. Patient length of stay, survival, and hospital cost/procedure were compared.ResultsConclusionsLVAD patients are older and sicker with more associated non-cardiac life threatening comorbidities. Donor shortages limit Tx intention to treat survival and often require LVAD bridging. Equipoise is impossible to accurately determine based upon differences in patient groups and intention to treat crossovers. Nevertheless, disparity in outcomes and cost between the procedures has narrowed over time. IntroductionCardiac transplantation (Tx) is the standard of care for terminal heart failure although limited donor availability, recipient selection restrictions and complications related to immunosuppression have made its impact epidemiologically trivial. The utility of LVAD support has been limited by poor survival, device complications and expense. Recently however, outcomes with the HeartMate II (HMII) have approached those of Tx making direct comparisons timely.