REMATCH - Left Ventricular Assist Device for Congestive Heart Failure


Eric A. Rose
Columbia Presbyterian Medical Center
New York, NY, USA

In a randomized, 22-center trial, end-stage heart failure patients who received a wearable left ventricular assist device had a documented survival benefit and improved quality of life. These results demonstrate that implantable, man-made heart pumps can prolong and enhance life in the treatment of advanced heart failure. Implanting a left ventricular assist device is now a viable alternative to transplant for these patients.

Left ventricular assist devices clearly benefit heart transplant candidates as a temporary solution when a human donor is not immediately available. These patients have enjoyed a reasonable improvement in quality of life, with an acceptable level of complications.

However, clinicians do not know the value of left ventricular device implantation as a part of long-term therapy for end-stage heart failure patients.

Dr. Rose and other investigators designed a randomized evaluation of long-term mechanical assistance for treatment of congestive heart failure. Investigators refer to this trial as REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure). The New England Journal of Medicine has published an early release of REMATCH results on the web at www.nejm.org.

The REMATCH trial included 129 patients with end-stage heart failure who were not eligible for cardiac transplantation. Investigators randomized patients to receive either the Thoratec Vented Electric Heartmate device or a control group of expert-guided optimal medical management.

Dr. Rose and colleagues hypothesized a 33% reduction in death rate over two years of observation for the group of patients who received the left ventricular assist device. Results show instead a 48% mortality reduction for the device group. One-year survival was 52%, versus 25% in the control group. Two-year survival was 23% versus 8%.

They also hypothesized that quality of life in implanted patients would equal or exceed controls. Indeed, these patients had a significantly improved quality of life one year after enrollment on validated scales such as the Beck Depression Inventory and New York Heart Association functional class.

Patients who received the device did have a significantly higher rate of complications. The frequency of serious complications was 2.35 times greater in this group. Most of the complications were infection, bleeding or device malfunction.

Nevertheless, investigators estimate implanting 1,000 patients with this device would save approximately 270 lives over one year. This is about four times the effect of angiotensin-converting enzyme inhibitors and beta-blockers. It is almost 30 times the effect of thrombolytics in treating acute myocardial infarction.

Dr. Rose said these results proved what physicians have hoped for decades: that an implantable, man-made heart pump device could prolong and enhance life.

He estimated the procedure would cost US$160,000, or about the cost of a heart transplant. However, that figure is very preliminary. Investigators are now determining the cost-effectiveness of this device as a treatment for advanced heart failure.


Reporter: Andrew Bowser