2017/02/01 by Joseph G. Rogers, Francis D. Pagani, Antone Tatooles +16 · 756 citations
Engineering · Medicine · #Cardiac Structural Anomalies and Repair #Cardiology #Clinical endpoint #Clinical trial #Confidence interval #Destination therapy #Ejection fraction #Heart failure #Heart transplantation #Internal medicine #Investigational device exemption #Mechanical Circulatory Support Devices #Medicine #Population #Randomized controlled trial #Relative risk #Stroke (engine) #Surgery #Transplantation: Methods and Outcomes #Ventricular assist device
paper · pdf · doi:10.1056/nejmoa1602954
published in New England Journal of Medicine 376(5), 451-460 (Massachusetts Medical Society)
openalex publication_date 2017/02/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/06
BACKGROUND: Mechanical circulatory support with a left ventricular assist device (LVAD) is an established treatment for patients with advanced heart failure. We compared a newer LVAD design (a small intrapericardial centrifugal-flow device) against existing technology (a commercially available axial-flow device) in patients with advanced heart failure who were ineligible for heart transplantation. METHODS: We conducted a multicenter randomized trial involving 446 patients who were assigned, in a 2:1 ratio, to the study (centrifugal-flow) device or the control (axial-flow) device. Adults who met contemporary criteria for LVAD implantation for permanent use were eligible to participate in the trial. The primary end point was survival at 2 years free from disabling stroke or device removal for malfunction or failure. The trial was powered to show noninferiority with a margin of 15 percentage points. RESULTS: The intention-to treat-population included 297 participants assigned to the study device and 148 participants assigned to the control device. The primary end point was achieved in 164 patients in the study group and 85 patients in the control group. The analysis of the primary end point showed noninferiority of the study device relative to the control device (estimated success rates, 55.4% and 59.1%, respectively, calculated by the Weibull model; absolute difference, 3.7 percentage points; 95% upper confidence limit, 12.56 percentage points; P=0.01 for noninferiority). More patients in the control group than in the study group had device malfunction or device failure requiring replacement (16.2% vs. 8.8%), and more patients in the study group had strokes (29.7% vs. 12.1%). Quality of life and functional capacity improved to a similar degree in the two groups. CONCLUSIONS: In this trial involving patients with advanced heart failure who were ineligible for heart transplantation, a small, intrapericardial, centrifugal-flow LVAD was found to be noninferior to an axial-flow LVAD with respect to survival free from disabling stroke or device removal for malfunction or failure. (Funded by HeartWare; ENDURANCE ClinicalTrials.gov number, NCT01166347 .).