"Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device"

New England Journal of Medicine 2009;361. Authors: Mark S. Slaughter, M.D., and others. This article was published on November 17, 2009, at NEJM.org.

"Background
Patients with advanced heart failure have improved survival rates and quality of life when treated with implanted pulsatile-flow left ventricular assist devices as compared with medical therapy. New continuous-flow devices are smaller and may be more durable than the pulsatile-flow devices.
Methods
In this randomized trial, we enrolled patients with advanced heart failure who were ineligible for transplantation, in a 2:1 ratio, to undergo implantation of a continuousflow device (134 patients) or the currently approved pulsatile-flow device (66 patients). The primary composite end point was, at 2 years, survival free from disabling stroke and reoperation to repair or replace the device. Secondary end points included survival, frequency of adverse events, the quality of life, and functional capacity.
Results
Preoperative characteristics were similar in the two treatment groups, with a median
age of 64 years (range, 26 to 81), a mean left ventricular ejection fraction of
17 per cent, and nearly 80 per cent of patients receiving intravenous inotropic agents. The primary composite end point was achieved in more patients with continuous-flow devices than with pulsatile-flow devices (62 of 134 [46%] vs. 7 of 66 [11%]; P<0.001; hazard ratio, 0.38; 95% confidence interval, 0.27 to 0.54; P 0.001), and patients with continuous-flow devices had superior actuarial survival rates at 2 years (58% vs. 24%, P = 0.008). Adverse events and device replacements were less frequent in patients with the continuous-flow device. The quality of life and functional capacity improved significantly in both groups.

Conclusions
Treatment with a continuous-flow left ventricular assist device in patients with advanced heart failure significantly improved the probability of survival free from stroke and device failure at 2 years as compared with a pulsatile device. Both devices significantly improved the quality of life and functional capacity."

Source (as a PDF Doc):
http://content.nejm.org