Destination Therapy

Indications for advanced heart failure therapy LVAD Left ventricular assist devices (LVADs) represent a promising option as a "destination therapy" for advanced-stage heart failure patients who do not respond to conventional therapy. The following list of risk factors offers a quick reference to help the cardiologist easily identify patients who should be considered for LVAD advanced heart failure therapy. Inability to walk one block without shortness of breath Sodium less than 136 BUN greater than 40 or Creatinine > 1.8 Inability to tolerate an ACE inhibitor, ARB or beta blocker Diuretic dosage greater than 1.5 mg/kg/d One admission for heart failure within the past 6 months QRS greater than or equal to 120ms Hematocrit less than 35 Click here to download a more in-depth map of LVAD referral indications for evaluation.

Select left ventricular assist devices (LVADs) have recently been approved for use as a destination, or permanent, therapy. This approach is used for patients with end stage heart failure who are ineligible for a transplant due to age, additional health problems, or other complications.

The landmark REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) trial found that end stage heart failure patients who received an LVAD device had a 52.1% chance of surviving a year, compared with a 24.7% survival rate for patients who took drugs and were medically monitored. At two years, the likelihood of survival was 22.9%for the LVAD patients versus 8.1% for those receiving medical therapies. In addition, patients reported significant improvements in their quality of life after receiving the LVAD. REMATCH was led by Eric A. Rose, MD, Chairman of the Department of Surgery at Columbia, and first appeared in the November 2001 New England Journal of Medicine.

Currently, the Thoratec HeartMate® XVE is the only FDA-approved device approved for use as a destination therapy. However, several devices are currently under investigation for this indication.

In March 2005, the NIH awarded Columbia University College of Physicians & Surgeons a $17 million SCCOR grant to investigate improving outcomes for end-stage heart failure patients with implanted mechanical devices. Eric A. Rose, MD, Chairman, Department of Surgery, is the principal investigator for the grant. Alan J. Moskowitz, MD, Co-Director of InCHOIR, and Mario Deng, MD, Director, Cardiac Transplantation Research, serve as co-principal investigators.