Left ventricular assist device:: a functional comparison with heart transplantation

Background. A growing number of patients with end-stage heart failure undergo implantation of ventricular assist devices as a bridge to heart transplantation. Objectives. In this study we investigated whether functional and haemodynamic recovery after implantation is sufficient to warrant the use of them as long-term alternative to heart transplantation. Methods. We compared peak VO2 of a group of patients three months after implantation of a ventricular assist device and three months after heart transplantation. Furthermore, we analysed the degree of haemodynaniic recovery, by comparing plasma levels of BNP and creatinine before and after implantation of the device. Results. After implantation of a ventricular assist device, exercise capacity improved considerably; three months after implantation peak VO2 was 20.0 4.9 ml/kg/min (52% of predicted for age and gender). After heart transplantation exercise capacity improved even further; 24.0 3.9 ml/ kg/min (62% of predicted for age and gender) (p < 0.001). In the three months after implantation, BNP plasma levels decreased from 570 307 pmol/l to 31 25 pmol/l and creatinine levels decreased from 191 82 pmol/l to 82 25 pmol/l, indicating significant unloading of the ventricles and haemodynamic recovery. Conclusion. With regard to functional and haemodynamic recovery, the effect of implantation of a ventricular assist device is sufficient to justify its use as an alternative to heart transplantation.