• E A Rose, A C Gelijns, A J Moskowitz, D F Heitjan, L W Stevenson, W Dembitsky, J W Long, D D Ascheim, A R Tierney, R G Levitan, J T Watson, P Meier, N S Ronan, P A Shapiro, R M Lazar, L W Miller, L Gupta, O H Frazier, P Desvigne-Nickens, M C Oz, V L Poirier, and Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group.
• College of Physicians and Surgeons, Columbia University, New York, NY, USA.
• N. Engl. J. Med. 2001 Nov 15; 345 (20): 1435-43.

BackgroundImplantable left ventricular assist devices have benefited patients with end-stage heart failure as a bridge to cardiac transplantation, but their long-term use for the purpose of enhancing survival and the quality of life has not been evaluated.MethodsWe randomly assigned 129 patients with end-stage heart failure who were ineligible for cardiac transplantation to receive a left ventricular assist device (68 patients) or optimal medical management (61). All patients had symptoms of New York Heart Association class IV heart failure.ResultsKaplan-Meier survival analysis showed a reduction of 48 percent in the risk of death from any cause in the group that received left ventricular assist devices as compared with the medical-therapy group (relative risk, 0.52; 95 percent confidence interval, 0.34 to 0.78; P=0.001). The rates of survival at one year were 52 percent in the device group and 25 percent in the medical-therapy group (P=0.002), and the rates at two years were 23 percent and 8 percent (P=0.09), respectively. The frequency of serious adverse events in the device group was 2.35 (95 percent confidence interval, 1.86 to 2.95) times that in the medical-therapy group, with a predominance of infection, bleeding, and malfunction of the device. The quality of life was significantly improved at one year in the device group.ConclusionsThe use of a left ventricular assist device in patients with advanced heart failure resulted in a clinically meaningful survival benefit and an improved quality of life. A left ventricular assist device is an acceptable alternative therapy in selected patients who are not candidates for cardiac transplantation.

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