Sahil Agrawal1, Lohit Garg2, Sudip Nanda3, Abhishek Sharma4, Nirmanmoh Bhatia5, Yugandhar Manda3, Amitoj Singh3, Mark Fegley3, Jamshid Shirani3. 1. Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA. Electronic address: Sahilagrwal124@gmail.com. 2. Department of Medicine, Beaumont Health System, Royal Oak, MI, USA. 3. Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA. 4. Division of Cardiology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA. 5. Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Abstract
BACKGROUND: Left ventricular assist devices (LVADs) and implantable cardioverter defibrillators (ICD) are each known to improve mortality in patients with advanced congestive heart failure (CHF). If ICDs contribute to improved survival specifically in recipients of LVADs is currently unknown. AIM: To evaluate the impact of presence of ICD on mortality in continuous flow LVAD recipients. METHODS: A meta- analysis of available literature was performed. PubMed, Embase and Google Scholar databases were searched for studies that compared mortality in continuous flow LVAD patients with ICDs (new implantation or no de-activation) and without ICDs (including de-activation of existing implant). Pooled analysis using a fixed effects model was used for outcomes of interest. RESULTS: We included 3 observational studies for a total of 292 patients (203 (69.5%) with ICD versus 89 (30.5%) without ICD). The presence of an active ICD was not associated with improved survival [OR 0.63, 95% CI 0.33-1.18; p=0.15]. In bridge to transplantation [BT] patients (224 patients, 149 with ICD versus 75 without ICD), an active ICD was not associated with a higher probability of survivzal [OR 1.47, 95% CI 0.78-2.76; p=0.23]. There was no difference in the occurrence of severe right ventricular dysfunction or failure between two groups [OR 0.78, 95% CI 0.42-1.47; p=0.45]. The risk of LVAD related complications were similar [OR 0.68, 95% CI 0.35-1.31; P=0.25]. CONCLUSION: This meta-analysis demonstrates that there is no survival benefit with ICD in heart failure patients supported with continuous flow LVAD. There is an urgent need of large-scale randomized trials to specifically address this issue.
BACKGROUND: Left ventricular assist devices (LVADs) and implantable cardioverter defibrillators (ICD) are each known to improve mortality in patients with advanced congestive heart failure (CHF). If ICDs contribute to improved survival specifically in recipients of LVADs is currently unknown. AIM: To evaluate the impact of presence of ICD on mortality in continuous flow LVAD recipients. METHODS: A meta- analysis of available literature was performed. PubMed, Embase and Google Scholar databases were searched for studies that compared mortality in continuous flow LVAD patients with ICDs (new implantation or no de-activation) and without ICDs (including de-activation of existing implant). Pooled analysis using a fixed effects model was used for outcomes of interest. RESULTS: We included 3 observational studies for a total of 292 patients (203 (69.5%) with ICD versus 89 (30.5%) without ICD). The presence of an active ICD was not associated with improved survival [OR 0.63, 95% CI 0.33-1.18; p=0.15]. In bridge to transplantation [BT] patients (224 patients, 149 with ICD versus 75 without ICD), an active ICD was not associated with a higher probability of survivzal [OR 1.47, 95% CI 0.78-2.76; p=0.23]. There was no difference in the occurrence of severe right ventricular dysfunction or failure between two groups [OR 0.78, 95% CI 0.42-1.47; p=0.45]. The risk of LVAD related complications were similar [OR 0.68, 95% CI 0.35-1.31; P=0.25]. CONCLUSION: This meta-analysis demonstrates that there is no survival benefit with ICD in heart failurepatients supported with continuous flow LVAD. There is an urgent need of large-scale randomized trials to specifically address this issue.
Authors: Kevin J Clerkin; Veli K Topkara; Donna M Mancini; Melana Yuzefpolskaya; Ryan T Demmer; Jose M Dizon; Koji Takeda; Hiroo Takayama; Yoshifumi Naka; Paolo C Colombo; A Reshad Garan Journal: J Heart Lung Transplant Date: 2016-12-01 Impact factor: 10.247
Authors: Travis D Richardson; Leslie Hale; Christopher Arteaga; Meng Xu; Mary Keebler; Kelly Schlendorf; Matthew Danter; Ashish Shah; JoAnn Lindenfeld; Christopher R Ellis Journal: J Am Heart Assoc Date: 2018-02-23 Impact factor: 5.501
Authors: Rakesh Gopinathannair; Henri Roukoz; Adarsh Bhan; Ashwin Ravichandran; Mustafa M Ahmed; Dmitry Familtsev; Geetha Bhat; Jennifer Cowger; Munazzah Abdullah; Chirag Sandesara; Rahul Dhawan; Emma J Birks; Jaimin R Trivedi; Mark S Slaughter Journal: J Am Heart Assoc Date: 2018-06-15 Impact factor: 5.501