Frequency of Poor Outcome (Death or Poor Quality of Life) After Left Ventricular Assist Device for Destination Therapy

Patients with end-stage heart failure are highly symptomatic and are expected to have a short life expectancy without intervention. For patients who are not candidates for heart transplantation, a left ventricular assist device (LVAD) may be an ideal treatment option as destination therapy, meaning that the patient is expected to live with the device until death (ie, not a bridge to heart transplant). Although an LVAD markedly improves survival and quality of life in the majority of such patients, the risk of mortality remains high even after implantation, despite continued improvements in device technology and surgical experience. Furthermore, many patients who undergo LVAD survive but continue to have poor quality of life because of a myriad of potential reasons, including refractory or recurrent heart failure symptoms, failure to recover from major cardiac surgery, or device-related complications such as bleeding, infections, stroke, and pump malfunction. Finally, the reasons that these patients are ineligible for heart transplantation—advanced age, noncardiac comorbidity, and frailty—may persist after LVAD implantation and can limit the ability of the patients to successfully regain a meaningful quality of life.