Original articleAdult cardiacLeft Ventricular Assist Device Destination Therapy Versus Extended Criteria Cardiac Transplant
Section snippets
Material and Methods
The Duke University Institutional Review Board approved the study design and protocol; individual patient consent was waived. All patients who presented to Duke University Medical Center between March 2000 and August 2008 with end-stage heart failure and who were ineligible for standard list cardiac transplantation were considered for EC-AL or DT-LVAD. Patients were screened for compliance, psychosocial stability, and appropriate insurance coverage. During this period, 153 consecutive patients
Results
Baseline and preoperative characteristics for the patients are shown in Table 1. The groups were similar except that DT-LVAD patients had higher body mass indices than EC-AL patients. Also, DT-LVAD patients appeared to be more decompensated as indicated by more need for intravenous inotrope support and greater preoperative central venous pressures. The incidence of prior cardiac surgery was higher among EC-AL patients. The EC-AL patients had a median preoperative mean pulmonary artery pressure
Comment
Advanced heart failure patients with class IV functional status and need for continuous intravenous inotropes have an 80% mortality at 1 year. Standard cardiac transplantation is not available for the majority of these patients [13]. Although both DT-LVAD and EC-AL have been proposed as therapeutic options for this group of patients, the two have never been compared [7, 8, 10, 11, 13, 14, 17].
We found that patients who were delegated to DT-LVAD more often required continuous intravenous
Acknowledgments
This work was funded by an unrestricted research grant from Thoratec Corporation (Pleasanton, CA) to Duke University Department of Surgery. All authors had full control of design of study, methods used, outcome determinants, analysis of data, and production of the written report.
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