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LVAD Destination Therapy — EECC MCQ

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ModerateHeart FailureLVAD Destination TherapyEECC

A 50-year-old man with non-ischaemic DCM (LVEF 15%) and refractory HF is assessed for LVAD as destination therapy. What is the main survival advantage demonstrated by the landmark REMATCH trial for LVADs?

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Correct answer: E — LVAD (destination therapy) significantly improved 1-year survival compared with medical therapy alone in patients ineligible for cardiac transplantation

The REMATCH trial (2001) was the landmark study establishing LVAD therapy as destination therapy (DT) for end-stage HF patients ineligible for cardiac transplantation. It demonstrated a 48% relative reduction in 1-year mortality with pulsatile-flow LVADs compared with optimal medical therapy (52% vs 25% survival at 1 year). Subsequent generations of continuous-flow LVADs (HeartMate II, HeartMate 3) have further improved outcomes, with the MOMENTUM 3 trial showing 2-year survival of ~80% with HeartMate 3. The ESC HF Guidelines recommend LVAD as DT for selected patients with end-stage HF who are not transplant candidates (Class IIa).

Reference: ESC (2023): Focused Update on Heart Failure; REMATCH Trial