Article type
Abstract
"Background: Heart failure (HF) is a significant cause of morbidity and mortality worldwide. Both left ventricular assist device (LVAD) implantation and heart transplantation are established treatments for advanced heart failure. However, comparative data on their clinical outcomes are limited.
Objective: To assess the comparative effectiveness of LVAD utilization in adults, aiming to determine its impact on reducing mortality and complications when contrasted with heart transplantation.
Methodology: A comprehensive literature search was conducted in PubMed, Google Scholar, and Cochrane databases following PRISMA guidelines. Studies comparing LVAD with heart transplantation in adult heart failure patients were included. Data extraction and quality assessment and meta-analysis with subgroup analyses and sensitivity analyses were performed to ensure comprehensive evaluation of outcomes.
Results: Twelve studies met the inclusion criteria, encompassing a total of 22,947 LVAD-treated patients and 48,648 heart transplantation patients. Meta-analysis at 95% CI revealed no significant difference in one-year, two-year, three-year, and five-year mortality rates between LVAD and heart transplantation. However, the incidence of stroke was higher with LVAD, while bleeding and infection rates were similar between the two groups.
Conclusion: HT is the gold standard for treating advanced heart failure. However, the demand for it exceeds the available supply, leading to challenges in meeting patient needs. LVAD implantation has shown comparable short-term mortality rates, although the associated risk of stroke was higher. LVAD can serve as a bridge to transplant (BTT) or destination therapy (DT) in select cases where heart transplantation is not immediately feasible. Individualized treatment decisions, considering patient characteristics and clinical scenarios, remain crucial in determining the most suitable intervention. Further research is needed for long-term outcomes and optimal management strategies for advanced heart failure patients.
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Objective: To assess the comparative effectiveness of LVAD utilization in adults, aiming to determine its impact on reducing mortality and complications when contrasted with heart transplantation.
Methodology: A comprehensive literature search was conducted in PubMed, Google Scholar, and Cochrane databases following PRISMA guidelines. Studies comparing LVAD with heart transplantation in adult heart failure patients were included. Data extraction and quality assessment and meta-analysis with subgroup analyses and sensitivity analyses were performed to ensure comprehensive evaluation of outcomes.
Results: Twelve studies met the inclusion criteria, encompassing a total of 22,947 LVAD-treated patients and 48,648 heart transplantation patients. Meta-analysis at 95% CI revealed no significant difference in one-year, two-year, three-year, and five-year mortality rates between LVAD and heart transplantation. However, the incidence of stroke was higher with LVAD, while bleeding and infection rates were similar between the two groups.
Conclusion: HT is the gold standard for treating advanced heart failure. However, the demand for it exceeds the available supply, leading to challenges in meeting patient needs. LVAD implantation has shown comparable short-term mortality rates, although the associated risk of stroke was higher. LVAD can serve as a bridge to transplant (BTT) or destination therapy (DT) in select cases where heart transplantation is not immediately feasible. Individualized treatment decisions, considering patient characteristics and clinical scenarios, remain crucial in determining the most suitable intervention. Further research is needed for long-term outcomes and optimal management strategies for advanced heart failure patients.
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