Left Ventricular Assist Devices for Destination Therapy: A Health Technology Assessment

 Left ventricular assist devices help keep blood flowing through the body by assisting a specific chamber in the hearts of patients with severe heart failure. A left ventricular assist device can be implanted as a last resort for patients with severe heart failure who cannot have heart transplantation; this is called destination (permanent) therapy. Earlier devices used pulsing flow pumps to mimic the natural pulsing action of the heart. Later devices produced a continuous flow of blood into the arteries. Only a continuous-flow device is currently licensed by Health Canada for destination therapy. Pulsing flow pumps are no longer licensed by Health Canada for destination therapy. 

In this report the medical and economic literature is reviewed to find out whether continuous-flow left ventricular assist devices improve patient outcomes (for example, increase survival, improve quality of life, reduce adverse events) and offers value for money over optimal medical (drug) therapy. One study compared pulsing flow pumps with drug therapy, and another study compared continuous-flow devices with pulsing flow pumps. We found no studies that compared continuous-flow devices with drug therapy; therefore we compared them indirectly. 

Overall, for patients with end-stage heart failure who are ineligible for heart transplantation, the review found that permanent treatment with continuous-flow devices is effective at improving survival and quality of life compared with drug therapy. The review also found that permanent continuous-flow devices have higher adverse event rates than drug therapy. Although it improves survival and quality of life, the device itself and the surgery to implant it are very expensive.