Continuos flow left ventricular assist device for end-stage heart failure: mild-term outcome and quality of life.

Introduction: Heart transplantation is actually the gold standard therapy for patients with end stage heart failure; unfortunately, the demands is much greater than the number of donors. The introduction of ventricular assist devices has changed the therapeutic possibilities for these patients. In this study, we evaluate the effectiveness and mild-term results of a continuos flow left ventricular assist device as definitive therapy. Methods:We evaluate 178 patients who received a Jarvik 2000 FlowMaker between June 2008 and december 2015 as "destination therapy". Concerning the etiology of heart failure, 90 patients (50,4 %) had a post-ischemic heart disease, 69 patients (38.8%) had an idiopathic dilated cardiomyopathy and 19 (10.7%) other pathologies such as hypertrophic cardiomyopathy and muscular dystrophy. At LVAD implantation time, the average INTERMACS level was 3±1.2. Post-operative clinical and instrumental evaluation of each patient was made every 3 month after implantation. The assessment of quality of life was carried out with the Short Form-36 Health Survey questionnaire, administered at 3, 6 and 9 months after LVAD implantation. Results: In 49 patients (27,8 %) the device has been implanted in a minimally invasive approach; in 100 patients (56,8 %), the device has been implanted without the extra-corporeal circulation. In 160 patients (90,9 %) a retroauricolar connection to driveline was used. The average time on system was 441 days and the averagesupport time of patients discharged out of hospital was 599 days. The cumulative support time was greater than 210 years. Concerning the survival rate, at 1 year is 82%, 60% at 2 years and 54 % at 3 years. Results show a significant progressive improvement in functional and mental status with results, at 9 months from LVAD implantation, similar to those of a healthy population. Conclusions: Clinical data suggest that technological evolution and an interdisciplinary approach to the patient could propose in the next years VAD therapy as a "gold standard" for end-stage heart failure.