LVAD Therapy: The Duke Difference

Treatment options have long been limited for the estimated 100,000 Americans with end-stage congestive heart failure (HF). Therapies include continuous inotropic infusions with a one-year survival rate of only 6 percent, and cardiac transplantation, which is limited by availability of donor organs.

 

Destination LVAD therapy represents a new option for end-stage HF patients who are ineligible for transplant. Extensive experience using LVADs to support patients as a bridge to transplantation has suggested that these devices can restore normal hemodynamics even in the setting of biventricular failure.

 

In the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial, end-stage HF patients who were ineligible for transplantation were randomized to optimal medical management versus implantable LVAD. Patients treated with LVADs experienced significant improvement in one and two year survival, as well as improved quality of life, relative to optimal medical management. This trial led to FDA approval of the HeartMate I device as a destination therapy for such patients in late 2002. Long-term results since REMATCH appear to be improving.

 

Duke is currently involved in three trials testing next generation LVADs in destination therapy. Newer devices such as the HeartMate II are smaller and quieter than the HeartMate I and feature an axial flow design which may provide greater durability.

Duke was among the first hospitals nationwide and the first in North Carolina to receive approval from the Centers for Medicare and Medicaid Services (CMS) to perform LVAD implantation as a destination therapy. To qualify for CMS reimbursement, centers had to meet strict criteria that includes VAD experience and demonstrated professional and facility quality performance metrics. Duke has implanted more than 100 LVADs over the last decade for bridge-to-transplant indication and performed the first destination therapy LVAD implant in North Carolina. Our highly experienced heart failure team offers a comprehensive approach to diagnosis and treatment using the latest in imaging, medical therapy, instruments, and surgical technique. As one of the highest volume LVAD centers in the country, Duke has the experience needed to insure successful LVAD outcomes.

Carmelo A. Milano, MD, Department of Surgery
Andrew J. Lodge, MD, Department of Surgery
Joseph G. Rogers, Department of Medicine
Laura Blue, NP

 

LVAD Brochure 

For more information about left ventricular assist device therapy, call 1-866-DUKEVAD (385-3823)