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Outcome of conservative management vs. assist device implantation in patients with advanced refractory heart failure
Author(s) -
Adlbrecht Christopher,
Hülsmann Martin,
Wurm Raphael,
Eskandary Farsad,
Neuhold Stephanie,
Zuckermann Andreas,
Bojic Andja,
Strunk Guido,
Pacher Richard
Publication year - 2016
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12562
Subject(s) - medicine , refractory (planetary science) , conservative management , ventricular assist device , heart failure , heart transplantation , conservative treatment , retrospective cohort study , surgery , transplantation , cardiology , physics , astrobiology
Background In patients with advanced refractory heart failure ( HF ) cardiac transplantation ( HTX ), conservative medical management and the implantation of a ventricular assist device ( VAD ) represent valuable options. The determination of the best therapeutic destination strategy for the individual patient remains a challenge. The aim of this study was to assess the clinical outcome in advanced refractory HF patients either managed conservatively receiving optimal contemporary medical therapy (‘conservative’), or who who underwent pulsatile flow VAD (‘ pVAD ’) or continuous‐flow VAD (‘cont VAD ’) implantation. Materials and methods A total of 118 patients with INTERMACS profile >1 at baseline, who died, or fully completed a 24‐month follow‐up free from HTX were included into this retrospective analysis. All‐cause mortality at 24 months was assessed and compared between the three groups. Results Fifty (42%) patients were managed conservatively, 25 (21%) received a pVAD and 43 (36%) a cont VAD . NT ‐pro BNP values were comparable between the three groups (median 4402 ( IQR 2730–13390) pg/mL, 3580 (1602–6312) pg/mL and 3693 (2679–8065) pg/mL, P = 0·256). Mean survival was 18·6 (95% CI 16·2–21·0) months for patients managed conservatively, 7·0 (3·9–10·0) for pVAD and 20·5 (18·2–22·8) for cont VAD (overall log‐rank test P < 0·001). Conservatively managed patients spent a mean of 22·4 (95% CI 22·1–22·8), pVAD 17·7 (15·4–20·1) and contVAD 21·6 (21·2–22·1) months out of hospital (conservative vs. pVAD P < 0·001; conservative vs. cont VAD P = 0·015; pVAD vs. contVAD P < 0·001). Conclusions In accordance with the literature, cont VAD resulted in a significantly better clinical outcome than pVAD implantation. However, conservative management with current optimal medical therapy appears to remain a valuable option for patients with advanced HF .