Authors' results and conclusions: Left ventricular assist devices (LVADs) appear to provide an increased survival time when compared to optimal medical therapy alone. The highest level of available evidence (Level II evidence) indicates that the implantation of an LVAD results in a median survival time of 408 days with an associated mortality rate of 60%, compared to a median survival time of 105 days and an associated mortality rate of 89% in the medical therapy group. The risk of death from all causes at all ages is reduced by almost 50% for patients implanted with a LVAD compared to patients receiving optimal medical therapy (RR=0.52, 95% CI [0.34,0.78]). One and two year survival rates for the LVAD group were 52% and 23% respectively, compared to 25% and 8% in the medical therapy group. Level IV evidence also indicates improvements in survival time, quality of life and the number of patients able to return to the home environment for those patients receiving LVAD. A number of serious adverse events are associated with the implantation of a LVAD including right heart failure, infection and sepsis, device malfunction, embolism and bleeding. In addition, a number of serious ethical issues are associated with the implantation of a permanent LVAD, including the process of withdrawing therapy, the balance of benefits and harms of therapy, and access to treatment and ongoing care.

Authors' recommendations: The use of LVADs as destination therapy for patients with cardiac failure is not supported for general use at this time. Trials of LVADs are currently underway and should be confined to centres of excellence that are established cardiac transplantation units, with experience in the implantation of LVADs as a bridge-to-transplantation. It should be noted that the use of LVADs as destination therapy, in the total context of the management of heart failure, raises significant ethical as well as clinical issues that will need to be addressed in a systematic and considered manner by the Australian community as the evidence becomes available.

Project Status: Completed

Year Published: 2004

URL for published report: Not Available

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)