Description of Treatment/Procedure

Left ventricular assist devices (LVADs) are effective therapy for short-term use and as a bridge to transplant in patients who are hemodynamically compromised due to cardiac failure. The success of this approach has led to speculation that LVADs may be suitable as permanent implants in patients with end-stage cardiac disease who are not eligible for transplant (also known as destination therapy). The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial was designed to compare LVADs with optimal medical therapy for the treatment of end-stage heart failure in patients ineligible for transplant.

Committee Summary

The ICSI Technology Assessment Committee finds that the following conclusions from the original report (approved December, 2000) remain unchanged:

1. LVADs are effective in replacing the pumping action of the heart allowing recovery of end-organ perfusion.
   
2. The safety and efficacy of LVADs as permanent implants for improving quality of life and longevity has not yet been proven. The results of the REMATCH trial are expected to provide a definitive answer.
   
3. As a short term bridge-to-transplant, LVADs have been found to be safe and effective when the patient is deteriorating faster than a donor organ is anticipated to be available.
   
4. LVAD therapy provides much improved and acceptable quality of life during extended use (up to several years) in the bridge-to-transplant population. (Conclusion Grade II)
   
5. The risks associated with surgical implantation of LVADs are acceptable if the risks and benefits of alternative therapy are considered.