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BACKGROUND: We sought to compare our long term, Destination Therapy (DT) experience using left ventricular assist devices (LVADs) to the REMATCH trial in order to determine whether outcomes had improved with this pioneering therapy for advanced heart failure.
METHODS: We retrospectively analyzed our institution’s post-REMATCH DT group (n=20, age=64±9.5 years), all presenting with NYHA class IV heart failure and all receiving HeartMate LVADs (Thoratec Corporation, Pleasanton, CA). Survival rates (Kaplan-Meier survival analysis and logrank analysis) and adverse events (using REMATCH definitions) were compared to the REMATCH LVAD group (n=71, age=66±9.1 years).
RESULTS: The survival rate at one year was 72% in the post-REMATCH DT group compared to the REMATCH survival rate of 54% (p=0.198). The two-year survival rates were 72% and 32% for the post-REMATCH and REMATCH groups, respectively (p=0.004). Logrank analysis over the entire period demonstrated improved survival (p=0.038). Adverse events occurred at a rate of 4.05 per patient year in the post-REMATCH group compared to the REMATCH rate of 6.45. Factors related to severity of illness (e.g. inotrope dependency and VO2max) were similar for both groups.
CONCLUSIONS:This single center experience, the largest thus far reported, supports the belief that survival and adverse events with long-term, Destination Therapy (DT) can be improved beyond the first formal experience encountered with the REMATCH trial. These results encourage continued pioneering with LVADs for the treatment of advanced heart failure.