QUALITY-OF-LIFE WITH AN IMPLANTED LEFT-VENTRICULAR ASSIST DEVICE

Background. With the increasing use of left ventricular assist devices (LVADs) for longer-term support of patients awaiting cardiac transpla ntation, we must now consider whether to use these devices as alternat ives to medical therapy when biologic hearts are needed but not forthc oming. This expansion of use depends as much on quality of life as it does on survival. To draw an inference about long-term quality of life with implanted LVADs, we studied ''bridged'' patients at our institut ion. Methods. We elicited, by standard gamble, the utilities (preferen ces) of bridged patients at three points in their care: before LVAD im plantation, during LVAD support, and after cardiac transplantation. Re sults. Utility was 0.548 (+/-0.276) before implantation, 0.809 (+/-0.1 36) during LVAD support, and 0.964 (+/-0.089) after transplantation. F or patients interviewed during all three states of health, the utiliti es were significantly different (p = 0.0009 by analysis of variance). Conclusions. The quality of life with an LVAD was substantially better than with medical therapy, on par with renal transplantation (as esta blished by others), and not as good as after cardiac transplantation. These results portend an acceptable quality of life for long-term use of LVADs for patients with end-stage heart failure and contribute to t he growing body of evidence supporting a clinical trial to test this n ew use. (C) 1997 by The Society of Thoracic Surgeons.