TOPLINE:

Adults younger than 50 years with advanced heart failure (HF) who received heart replacement therapy with a left ventricular assist device (LVAD) had survival outcomes similar to those who underwent heart transplantation and had a lower risk for death than patients on the waiting list for a transplant.

METHODOLOGY:

• Researchers compared survival outcomes and adverse events in young patients (18-49 years) with advanced HF who received the HeartMate 3 LVAD vs those listed for or who underwent heart transplantation.
• They used data on LVAD recipients from two linked trials and a national transplant registry to identify patients listed for or who underwent heart transplantation. Patients were matched for key clinical variables to yield balanced cohorts for comparison.
• The final analysis included 373 LVAD recipients matched to 373 patients listed for transplant and 298 LVAD recipients matched to 298 transplant recipients. Mean ages were about 40 years in both comparisons, and roughly one quarter of patients were women.
• The primary outcome was freedom from death or delisting due to clinical deterioration among patients listed for transplantation, assessed over a follow-up period of 2 years. Researchers also assessed the occurrence of major adverse events within 1 year of treatment.

TAKEAWAY:

• The 2-year survival rate was 88.7% for LVAD recipients and 90.2% for transplant recipients, with no significant difference in the risk (hazard ratio, 1.18; P = .53).
• LVAD recipients had a 62% lower risk for death than patients listed for heart transplantation (P < .0001).
• Within 1 year of treatment, LVAD recipients had lower rates of renal dysfunction requiring dialysis (5.0% vs 10.4%) and infection-related hospitalizations (24.8% vs 34.2%; P < .05 for both) than recipients of heart transplantation.
• LVAD recipients had a higher occurrence of stroke than patients who underwent heart transplantation (3.4% vs 0.3%; P = .027), although the overall event rate remained low.

IN PRACTICE:

“These findings support the consideration of an LVAD-first strategy as a viable initial approach to heart replacement therapy in appropriately selected patients,” researchers of the study wrote.

SOURCE:

This study was led by Nir Uriel, MD, of the Columbia University Irving Medical Center in New York City. It was published online on February 09 in JACC: Heart Failure.

LIMITATIONS:

Data on LVAD recipients were retrieved from clinical trials, which may have limited the generalizability of the findings. The findings were derived from data spanning 2014-2018, which may not have reflected later or current clinical practices and policies. The 2-year follow-up duration might have been inadequate to study long-term outcomes.

DISCLOSURES:

The LVAD has been developed by Abbott, and the study used data from studies sponsored by Abbott. Several authors disclosed receiving consulting fees, personal fees, research grants, and/or speaker fees and having other financial ties with Abbott and other pharmaceutical and healthcare companies. Two authors declared being employees of Abbott.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.