Why the study?
Does heart transplantation improve survival compared to durable left ventricular assist devices in patients with advanced heart failure?
Does heart transplantation improve survival compared to durable left ventricular assist devices in patients with advanced heart failure?
This editorial highlights that while modern LVAD survival rates are approaching those of heart transplantation, conducting a head-to-head randomized trial remains formidably challenging.
Triage of patients referred with advanced heart failure (HF) continues to revive the classic question: can we conduct a randomized trial comparing heart transplantation with durable left ventricular assist devices (LVADs)? Survival with the HeartMate III has improved, exceeding ∼80% at 2 years and approaching 60% at 5 years, often with good quality of life—results that appear similar to those observed at 2 and 5 years after heart transplantation.1 What results would we anticipate from a trial that compares replacement of failing hearts using donated human hearts requiring immunosuppression with the implantation of LVADs to support failing hearts that remain in place? Although such answers would be welcome, conducting such a randomized trial poses formidable challenges.
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Lima et al. (2026) conducted an editorial in Advanced heart failure. Heart transplantation vs. Left ventricular assist devices (LVADs) was evaluated.
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