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Discussion on left ventricular assist device (LVAD).
Left ventricular assist device is used to support the failing left ventricle when it is refractory to guideline directed medical therapy. It can be either a bridge to cardiac transplantation or a destination therapy.
In general, cardiac transplantation offers better long term survival compared to LVAD according to data available from devices except the most recent.
As per The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017, there were 126,753 pediatric and adult heart transplants between 1982 and June 2015.
Median survival after heart transplantation was 10.7 years in adults and 16.1 years in pediatric recipients.
Data published by Evolving Mechanical Support Research Group Investigators in 2018 quotes the median survival with LVAD among 156 long term survivors between 2005 and 2010 as 7.1 years.
It is notable that at 2 years after implantation 97% were in either NYHA functional class I or II. It was 92% at 4 years after implantation of left ventricular assist device.
MOMENTUM 3 trial 1- and 2-year survival rates for the HeartMate 3 was published 2019.
HeartMate 3 is a fully magnetically levitated LVAD. Fully magnetically levitated centrifugal-flow LVAD recipients are less likely to have pump thrombosis or nondisabling stroke than those treated with a mechanical-bearing axial-flow LVAD at 2 year follow up.
Reoperation to replace or remove a malfunctioning device was lower this group. Let us hope that the long term results of the MagLev devices will also be good.

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