PMID- 12016626
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20020731
LR  - 20191106
IS  - 1071-9164 (Print)
IS  - 1071-9164 (Linking)
VI  - 8
IP  - 2
DP  - 2002 Apr
TI  - Comment--the REMATCH trial: Long-term use of a left ventricular assist device for 
      end-stage heart failure.
PG  - 59-60
AB  - BACKGROUND: Implantable left ventricular assist devices (LVADs) have been used 
      primarily as bridges to cardiac transplantation, although some patients have been 
      maintained long term on these devices and a few have recovered enough to be 
      weaned. This trial was designed to evaluate their suitability as long-term 
      myocardial replacement therapy in patients who are ineligible for cardiac 
      transplantation. METHODS AND RESULTS: One hundred twenty-nine patients with 
      end-stage heart failure who were ineligible for cardiac transplantation were 
      randomly assigned to receive an LVAD (Thoratec HeartMate; Thoratec, Pleasanton, 
      CA) or optimal medical therapy, with a primary end point of all-cause mortality. 
      To be eligible, patients had to have New York Heart Association (NYHA) class IV 
      heart failure for at least 90 days despite attempted therapy with an 
      angiotensin-converting enzyme inhibitor, diuretics, and digoxin; an ejection 
      fraction </=25%; and an exercise peak O(2) uptake </=12 mL. kg(-1). min(-1) 
      (later increased to 14 mL. kg(-1). min(-1)). Patient eligibility was approved by 
      a gatekeeper at the coordinating center. RESULTS: Survival was significantly 
      improved from 25% at 1 year in the medical therapy group to 52% in the LVAD group 
      (relative risk, 0.52; 95% confidence interval, 0.34-0.78; P = 0.001). However, at 
      2 years only 23% in the LVAD group were alive (compared with 8% in the medical 
      group). Fifty of 54 deaths in the medical group were caused by left ventricular 
      dysfunction; in the LVAD group, of the 41 total deaths, 17 were caused by sepsis, 
      7 by LVAD failure, 4 by cerebrovascular disease, 2 by pulmonary embolus, and only 
      1 by left ventricular dysfunction. Serious adverse events were 2.35 times as 
      frequent in the LVAD group, predominately caused by infection, bleeding, 
      neurologic dysfunction, and device malfunction. NYHA class improved in all LVAD 
      survivors at 1 year. Quality of life was significantly improved more compared 
      with the medical therapy group by some indices, but not by the Minnesota Living 
      With Heart Failure Questionnaire. CONCLUSIONS: The use of an LVAD resulted in 
      improved survival and quality of life in patients with extremely severe heart 
      failure (75% 1-year mortality in the medical control group). However, only 23% of 
      LVAD patients survived to 2 years and complications were frequent.
FAU - Hunt, Sharon A
AU  - Hunt SA
AD  - Stanford, California, USA.
LA  - eng
PT  - Comment
PT  - Journal Article
PL  - United States
TA  - J Card Fail
JT  - Journal of cardiac failure
JID - 9442138
CON - N Engl J Med. 2001 Nov 15;345(20):1435-43. PMID: 11794191
EDAT- 2002/05/23 10:00
MHDA- 2002/05/23 10:01
CRDT- 2002/05/23 10:00
PHST- 2002/05/23 10:00 [pubmed]
PHST- 2002/05/23 10:01 [medline]
PHST- 2002/05/23 10:00 [entrez]
AID - S107191640280598X [pii]
AID - 10.1054/jcaf.2002.32944 [doi]
PST - ppublish
SO  - J Card Fail. 2002 Apr;8(2):59-60. doi: 10.1054/jcaf.2002.32944.