{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T03:02:34Z","timestamp":1768791754191,"version":"3.49.0"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2015,12,23]],"date-time":"2015-12-23T00:00:00Z","timestamp":1450828800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In patients with advanced refractory heart failure (<jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>) cardiac transplantation (<jats:styled-content style=\"fixed-case\">HTX<\/jats:styled-content>), conservative medical management and the implantation of a ventricular assist device (<jats:styled-content style=\"fixed-case\">VAD<\/jats:styled-content>) represent valuable options. The determination of the best therapeutic destination strategy for the individual patient remains a challenge. The aim of this study was to assess the clinical outcome in advanced refractory <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content> patients either managed conservatively receiving optimal contemporary medical therapy (\u2018conservative\u2019), or who who underwent pulsatile flow <jats:styled-content style=\"fixed-case\">VAD<\/jats:styled-content> (\u2018<jats:styled-content style=\"fixed-case\">pVAD<\/jats:styled-content>\u2019) or continuous\u2010flow <jats:styled-content style=\"fixed-case\">VAD<\/jats:styled-content> (\u2018cont<jats:styled-content style=\"fixed-case\">VAD<\/jats:styled-content>\u2019) implantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>A total of 118 patients with <jats:styled-content style=\"fixed-case\">INTERMACS<\/jats:styled-content> profile &gt;1 at baseline, who died, or fully completed a 24\u2010month follow\u2010up free from <jats:styled-content style=\"fixed-case\">HTX<\/jats:styled-content> were included into this retrospective analysis. All\u2010cause mortality at 24 months was assessed and compared between the three groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty (42%) patients were managed conservatively, 25 (21%) received a <jats:styled-content style=\"fixed-case\">pVAD<\/jats:styled-content> and 43 (36%) a cont<jats:styled-content style=\"fixed-case\">VAD<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\u2010pro<jats:styled-content style=\"fixed-case\">BNP<\/jats:styled-content> values were comparable between the three groups (median 4402 (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 2730\u201313390) pg\/mL, 3580 (1602\u20136312) pg\/mL and 3693 (2679\u20138065) pg\/mL, <jats:italic>P<\/jats:italic> = 0\u00b7256). Mean survival was 18\u00b76 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 16\u00b72\u201321\u00b70) months for patients managed conservatively, 7\u00b70 (3\u00b79\u201310\u00b70) for <jats:styled-content style=\"fixed-case\">pVAD<\/jats:styled-content> and 20\u00b75 (18\u00b72\u201322\u00b78) for cont<jats:styled-content style=\"fixed-case\">VAD<\/jats:styled-content> (overall log\u2010rank test <jats:italic>P<\/jats:italic> &lt; 0\u00b7001). Conservatively managed patients spent a mean of 22\u00b74 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 22\u00b71\u201322\u00b78), <jats:styled-content style=\"fixed-case\">pVAD<\/jats:styled-content> 17\u00b77 (15\u00b74\u201320\u00b71) and contVAD 21\u00b76 (21\u00b72\u201322\u00b71) months out of hospital (conservative vs. <jats:styled-content style=\"fixed-case\">pVAD <\/jats:styled-content><jats:italic>P<\/jats:italic> &lt; 0\u00b7001; conservative vs. cont<jats:styled-content style=\"fixed-case\">VAD <\/jats:styled-content><jats:italic>P<\/jats:italic> = 0\u00b7015; <jats:styled-content style=\"fixed-case\">pVAD<\/jats:styled-content> vs. contVAD <jats:italic>P<\/jats:italic> &lt; 0\u00b7001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In accordance with the literature, cont<jats:styled-content style=\"fixed-case\">VAD<\/jats:styled-content> resulted in a significantly better clinical outcome than <jats:styled-content style=\"fixed-case\">pVAD<\/jats:styled-content> implantation. However, conservative management with current optimal medical therapy appears to remain a valuable option for patients with advanced <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.12562","type":"journal-article","created":{"date-parts":[[2015,11,5]],"date-time":"2015-11-05T14:20:55Z","timestamp":1446733255000},"page":"34-41","source":"Crossref","is-referenced-by-count":10,"title":["Outcome of conservative management vs. assist device implantation in patients with advanced refractory heart failure"],"prefix":"10.1111","volume":"46","author":[{"given":"Christopher","family":"Adlbrecht","sequence":"first","affiliation":[{"name":"Division of Cardiology Department of Medicine II Medical University of Vienna Vienna Austria"},{"name":"4th Medical Department Hietzing Hospital Medical University of Vienna Vienna 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