LVAD Survival Better When Combined with ICD

Researchers at the Minneapolis Veterans Affairs (VA) Health Care System (MN, USA) conducted a systematic review and meta-analysis of studies published in PubMed and OVID databases from January 2000 through October 2015 in order to evaluate the impact of ICDs on mortality in patients with LVADs. In all, six relevant studies were identified, which included 937 patients (mean age 53 years, 80% male). A continuous-flow LVAD was present in 39% of the patients, and an ICD was present in 38%.

The results showed that among LVAD patients, all-cause mortality rates were 16% with an ICD, versus 32% without one, over a mean follow-up period of 7 months. Patients with newer, continuous flow LVADs showed a similar, but non-significant trend for better survival with an ICD (14% versus 25%, respectively). The authors acknowledged that they failed to totally exclude patients with biventricular assist devices (17%) and right ventricular assist devices (4%). The study was published in the July 2016 issue of JACC: Heart Failure.

“The evidence supporting ICD use in patients with LVADs is limited to a few, relatively small studies. Current practice guidelines supporting ICD use in LVAD patients are therefore predominantly based on expert consensus and observational studies,” wrote lead author Kairav Vakil, MD, and colleagues, adding that, “this cohort was enriched with patients that received an LVAD as bridge-to-transplantation. As such, these results cannot be generalized to patients receiving destination therapy LVADs, who are known to be relatively sicker than those awaiting transplantation.”

An LVAD is intended to complement a weakened heart by providing circulatory support. Surgically implanted in proximity to the heart, one end is attached to the left ventricle, while the other is attached to the aorta. Blood flows from the ventricles into the pump and is then ejected out of the device and into the aorta. Although the mechanism of survival benefit from ICDs in LVAD patients remains unclear, a possible explanation is that it may contribute to a reduction in harmful effects of ventricular arrhythmias on right ventricular function, thereby leading to reduction of heart failure deaths.

Related Links:
Minneapolis Veterans Affairs