Abstract

The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial has proven the superiority of Left Ventricular Assist Device (LVAD) therapy over optimal medical therapy for patients with refractory heart failure. Since the approval of LVAD use for "destination therapy" (DT), the number of accredited DT centers has increased without a corresponding increase in demand. The resulting low-volume programs are correlated with poor outcomes. However, University Hospitals in Cleveland, OH has had excellent survival. All DT LVAD patients at UH were compared to the INTERMACS database, which does not differentiate between DT and bridge-to-transplant patients. A number of hematologic, hepatic, and renal laboratory values were significantly closer to normal in UH patients when compared to INTERMACS. Additionally, UH patients spent significantly less time in cardiopulmonary bypass and were aggressively treated for right heart dysfunction. With appropriate patient selection, infrastructure, and perioperative management, even a low volume program can achieve excellent survival.