Destination Therapy for Heart Failure: What to do When the Batteries Run Out?

12th Biennial Meeting of the International Andreas Gruentzig Society:  Rio de Janeiro - February 2-6, 2014

Destination Therapy for Heart Failure:  What to do When the Batteries Run Out?

There has been considerable success in treating end-stage acute and chronic heart failure in selected groups of patients, however, we must bear in mind there is considerable LVAD mortality at 1 year — about 50%, and nearly 90% at 3-year follow-up.
There are no clear indications for LVAD use and no means to identify the patients who are the most likely to survive aggressive support devices. Finally, we don’t know how to plan preprocedural assessment for optimal device placement.

What are the gaps in the current knowledge?

  • One of most important areas of research should be prevention of thrombotic complications.
  • We also need comprehensive risk stratification of patients for complications. We currently have no good risk assessment tool for preprocedure device selection.
  • We need more options and more clinical trial data. Perhaps ongoing Impella and Tandem Heart studies can shed more light on influence on outcomes of cardiogenic shock and infarct size reduction.

Our Summary and Recommendations:

  • Ethical concerns need to be better outlined.
  • Better designed clinical trials are absolutely mandatory in order to move forward in our understanding of the role of devices in outcomes.
  • We believe there is a great need for better devices and better techniques to improve outcome.
  • We need further studies to determine if patient selection can really improve destination therapy.
  • Not particularly cost effective and associated with very high rate of mortality.