Background: The current treatment options available for end-stage heart failure include heart transplantation (HTx) and left ventricular assist devices (LVADs). Despite comparable efficacy and safety profiles, the reliability of LVAD therapy as an alternative to the standard HTx still controversial. Moreover, the choice among different LVADs types in candidate patients is unclear.
Aim of the Work: To compare HTx vs LVADs in adult end stage heart failure population, evaluate destination therapy (DT) vs bridge to therapy (BTT) as indications for LVADS, and characterizes individual safety profiles for commercially available LVADs including Heart Ware, Heart Mate II, and Heart Mate III.
Patients and Methods: A systematic search of Egyptian knowledge bank (EKB), PubMed, and Cochrane databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four types of comparisons were set in the current analysis: HTx vs LVADs, DT vs BTT, Heart Ware vs Heart Mate II, and Heart Mate II vs Heart Mate III. The primary endpoint assessed was the all-cause mortality. Secondary endpoints were the complication rates relevant to either modality including organ failure, infection rates and device related complications (for LVADs only).
Results: The present study systemically analyzed 6734 patients derived from 12 studies including 10 observational and 2 randomized controlled trials (RCTs). Comparing HTx to LVAD, there were no significant differences between both modalities regarding mortality, stroke, infection, bleeding, hospital readmission, and renal failure. However, HTx demonstrated significantly higher right ventricular failure (RVF) rates (P = 0.005). When comparing DT vs BTT indications, non-significant differences were found regarding the rates of mortality, infection, bleeding, RVF, and device malfunction. Nevertheless, significantly lower rates of stroke were demonstrated with BTT (P = 0.02). Comparison between different LVADs demonstrated significantly higher rates VAD infections (P = 0.03), neurological complications (P <0.001), and RVF in Heart Ware compared to Heart Mate II. Conversely, Heart Mate III demonstrated significantly lower rates of stroke (P = 0.02) and device malfunction (P< 0.001) compared to Heart Mate II.
Conclusion: The findings of this meta-analysis indicate that LVAD may serve as a potential alternative to heart transplantation in patients with end-stage heart failure.