Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure
| Autor: | Patrice Desvigne-Nickens, V L Poirier, Eric A. Rose, W Dembitsky, P A Shapiro, Nuala S. Ronan, P Meier, Mehmet C. Oz, Ronald M. Lazar, Annetine C. Gelijns, R G Levitan, Alan J. Moskowitz, D D Ascheim, John T. Watson, L.W. Stevenson, Leslie W. Miller, O.H. Frazier, Anita R. Tierney, L Gupta, J W Long, Daniel F. Heitjan |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Severity of Illness Index Cause of Death Internal medicine Activities of Daily Living medicine Humans Ventricular Assist Device Placement Survival analysis Aged Cause of death Heart Failure business.industry Equipment Design General Medicine Middle Aged medicine.disease Survival Analysis Transplantation Right Ventricular Assist Device Ventricular assist device Heart failure Quality of Life Cardiology Equipment Failure Female Heart-Assist Devices business Destination therapy |
| Zdroj: | New England Journal of Medicine. 345:1435-1443 |
| ISSN: | 1533-4406 0028-4793 |
| Popis: | Implantable left ventricular assist devices have benefited patients with end-stage heart failure as a bridge to cardiac transplantation, but their long-term use for the purpose of enhancing survival and the quality of life has not been evaluated.We randomly assigned 129 patients with end-stage heart failure who were ineligible for cardiac transplantation to receive a left ventricular assist device (68 patients) or optimal medical management (61). All patients had symptoms of New York Heart Association class IV heart failure.Kaplan-Meier survival analysis showed a reduction of 48 percent in the risk of death from any cause in the group that received left ventricular assist devices as compared with the medical-therapy group (relative risk, 0.52; 95 percent confidence interval, 0.34 to 0.78; P=0.001). The rates of survival at one year were 52 percent in the device group and 25 percent in the medical-therapy group (P=0.002), and the rates at two years were 23 percent and 8 percent (P=0.09), respectively. The frequency of serious adverse events in the device group was 2.35 (95 percent confidence interval, 1.86 to 2.95) times that in the medical-therapy group, with a predominance of infection, bleeding, and malfunction of the device. The quality of life was significantly improved at one year in the device group.The use of a left ventricular assist device in patients with advanced heart failure resulted in a clinically meaningful survival benefit and an improved quality of life. A left ventricular assist device is an acceptable alternative therapy in selected patients who are not candidates for cardiac transplantation. |
| Databáze: | OpenAIRE |
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