Aggressive conservative therapy achieved and maintained clinical stabilization in 75% (21 of 28) of advanced heart failure patients fulfilling criteria for LVAD implantation over a median 20 months.
Cohort (n=28)
No
Can aggressive conservative therapy achieve long-term clinical stabilization and defer LVAD implantation in patients with advanced heart failure?
Aggressive conservative medical therapy can safely defer LVAD implantation in a majority of advanced heart failure candidates.
Abstract Aims Clinical trials comparing LVADs vs. conservative therapy were performed before the availability of novel medications or used suboptimal medical therapy. This study aimed to report that long-term stabilization of patients entering a left ventricular assist device (LVAD) programme is possible with the use of aggressive conservative therapy. This is important because the excellent clinical stabilization provided by LVADs comes at the expense of significant complications. Methods and results This study was a single-centre prospective evaluation of consecutive patients with advanced heart failure (HF) fulfilling criteria for LVAD implantation based on clinical and echocardiographic characteristics, cardiopulmonary exercise test, and right heart catheterization results. Their initial therapy included inotropes, thiamine, beta-blockers, digoxin, spironolactone, hydralazine, and nitrates followed by the introduction of novel HF therapies. Coronary revascularization and cardiac resynchronization therapy were performed when indicated, and all patients were closely followed at our outpatient clinic. During the study period, 28 patients were considered suitable for LVAD implantation (mean age 63 ± 10.8 years, 92% men, 78% ischaemic, median HF duration 4 years). Clinical stabilization was achieved and maintained in 21 patients (median follow-up 20 months, range 9–38 months). Compared with baseline evaluation, cardiac index increased from 2.05 (1.73–2.28) to 2.88 (2.63–3.55) L/min/m2, left ventricular end-diastolic diameter decreased from 65.5 (62.4–66) to 58.3 (53.8–62.5) mm, and maximal oxygen consumption increased from 10.1 (9.2–11.3) to 16.1 (15.3–19) mL/kg/min. Three patients died and only four ultimately required LVAD implantation. Conclusions Notwithstanding the small size of our cohort, our results suggest that LVAD implantation could be safely deferred in the majority of LVAD candidates.
Havakuk et al. (Tue,) conducted a cohort in Advanced heart failure (n=28). Aggressive conservative therapy was evaluated on Clinical stabilization. Aggressive conservative therapy achieved and maintained clinical stabilization in 75% (21 of 28) of advanced heart failure patients fulfilling criteria for LVAD implantation over a median 20 months.