Evaluation of a new approach to the management of advanced chronic heart failure: use of implantable left ventricular assist devices as a bridge to heart transplantation in the UK

Introduction: Heart Transplantation (HTx) remains the standard treatment for patients with advanced chronic heart failure (ACHF). Over the last 20 years, despite rising donor numbers, practitioners have observed a decline in the numbers of adult HTx in the UK. Due to this decline and due to increasing waiting times for HTx more patients are requiring a ventricular assist device (VAD) as a bridge to heart transplantation (BTT). This work aims to evaluate VAD practice in the UK and to describe outcomes, which include survival and quality of life. Methods: A national audit study was undertaken to collect VAD data. The data was recorded in a database and analysed. An audit of quality of life was also undertaken and all adult HTx centres participated. Quality of life (QoL) data was collected from patients who were being medically treated for ACHF; patients who had received a VAD and patients who had received a heart transplant. Results: 247 patients received VADs within the study period. The use of 3rd-gen devices increased over time. The median duration of support increased from 141 days (interquartile range 80 to 253 days) to 578 days (lower quartile 204 days). Survival improved with device generation (p=0.003). At 1-year, 50.0% of patients receiving a 1st generation device were alive (95% CI 34.9 to 63.3%) compared to 76.9% of patients receiving a 3rd generation device (95%CI 68.0 to 83.6%). 386 patients completed QoL questionnaires. Patients after HTx reported the best QoL; patients with LVADs reported better QoL scores than patients being assessed for HTx and patients listed for HTx on medical therapy. Conclusions: VAD implantation has improved and increased, and has become a credible option for some patients awaiting HTx. Quality of life for patients with VADs is better than patients being treated with maximal medical therapyOpen Acces