Left ventricular assist device as destination therapy for end stage heart failure
Bibliographic record
Abstract
PURPOSE OF REVIEW: Cardiac transplantation is the gold standard treatment for patients with end-stage heart failure. Unfortunately, the demand for donor organs far outstrips the number of available hearts. Therefore, not all patients who can benefit from this therapy are even listed for transplant. Once destination therapy was approved for the long-term support of nontransplant eligible patients, it was felt that the number of durable ventricular assist device (VAD) implants would increase. It was not until the current generation continuous-flow VADs became available that the number of DT-VAD implants grew significantly. The purpose of this manuscript is to review current indications and outcomes following durable VAD implant for destination therapy. RECENT FINDINGS: In 2014, DT-VADs accounted for 46% of all implants. A propensity-matched analysis showed that 1-year and 2-year survival rates were similar between LVADs and cardiac transplantation. Likely because of their younger age and lack of comorbidities, survival after VAD implant in transplant eligible patients remains higher than after DT-VAD implant. However, the survival differences are narrowing. Although the rates of LVAD-related adverse events continue to be high, studies such as the PREVENT trial have proven that strict adherence to management protocols can reduce event rates. SUMMARY: Improvements in device technology as well as patient selection and management have led to improved medium term (2-4 years) survival after VAD implant in nontransplant eligible patients. We anticipate that this technology will soon be a reasonable and competitive alternative to conventional heart transplantation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".