LVAD Versus GDMT in Ambulatory Advanced Heart Failure Patients

  • STATUS
    Recruiting
  • End date
    Feb 10, 2025
  • participants needed
    92
  • sponsor
    Hospices Civils de Lyon
Updated on 10 March 2021

Summary

Heart failure is a severe disease affecting approximately 1-2% of the adult population in developed countries and around 26 million people worldwide. Up to 10% of these patients are in advanced stage heart failure, which is defined by a significant morbimortality and considerable medical expenses. Despite advances in its medical management, advanced (or end stage) heart failure is characterized by refractoriness to conventional therapies including guideline-directed pharmacological and non-surgical device treatments. These patients remain severely symptomatic (NYHA IV) and have objective signs of congestion or low cardiac output.

Left ventricular assist devices (LVADs) have been used in patients with heart failure with reduced ejection fraction for almost 20 years either as an alternative or a bridge to heart transplantation. LVADs improve heart failure symptoms and survival at the cost of increased rates of infection, stroke and bleeding.

Despite the lack of evidence, LVAD implantation in ambulatory patients is not rare, with INTERMACS profiles 4 patients representing 15.7% of the overall population implanted between 2012 and 2016.

The aim of this study is to investigate the efficacy and safety of left ventricular assist devices compared to traditional HF medical treatment alone in a population of ambulatory advanced heart failure patients. Secondary objectives are to better identify subgroups of patients that would benefit the most from the implantation of an LVAD as well as to assess the optimal timing of intervention.

Details
Condition End Stage Heart Failure
Treatment HeartMate 3 TM Left Ventricular Assist System, Guideline Directed Medical Therapy
Clinical Study IdentifierNCT04768322
SponsorHospices Civils de Lyon
Last Modified on10 March 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

All patients 18 years
End-stage heart failure, evaluated by the local Heart Team, defined as
Left ventricular ejection fraction 30% within 1 week prior to randomization and
Cardiac Index < 2.2 L/min/m by hemodynamic use within 1 month prior to randomization and
VO2 max < 14 ml/kg/min (or <50% of predicted VO2max) or low 6-min walking test (<300 m) and
NYHA III-IV (INTERMACS profile 4-6) or 2 hospitalizations for heart failure in the past year and
Receiving medical management with optimal doses of betablockers, Angiotensin-Converting-Enzyme-inhibitors or Angiotensin II Receptor Blockers or angiotensin receptor neprilysin inhibitor (if eligible) and Mineralocorticoid Receptor Antagonists for at least 45 days if tolerated according to guideline at maximal tolerated dose (if maximal HF drug dosage is not reached the investigators will have to explain reason behind not maximal dosage)
Receiving Cardiac Resynchronization Therapy and or Implantable Cardioverter Defibrillators if indicated for at least 45 days and
No mechanical circulatory support or inotrope therapy since > 30 days
Having a health coverage
Signed written informed consent
Patient without any legal protection measure

Exclusion Criteria

Inotrope dependent patients or existence of ongoing mechanical circulatory support (MCS) in the last 30 days
Right ventricular dysfunction (heart team consensus) with the expected need of Bi-VAD support
Female patients currently pregnant or women of childbearing age who were not using contraception
Active infection
Irreversible end-organ dysfunction prior to LVAD implantation
Contraindication to anti-coagulant or anti-platelet therapies
History of any organ transplant prior to inclusion
Psychiatric disease/disorder, irreversible cognitive dysfunction or psychosocial issues likely to impair compliance
Frailty according to heart team
Platelet count < 100,000 x 103/liter (<100,000/ml)
Body Surface Area (BSA) < 1.2 m2
Any condition other than heart failure that could limit survival to less than 24 months
Chronic renal insufficiency (GFR <30 ml/min) or hepatic cirrhosis
Participation in any other interventional clinical investigation
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