Introduction Heart failure (HF) is a leading cause of mortality worldwide, and heart transplantation remains the gold standard treatment. However, due to the scarcity of donor organs, Left Ventricular Assist Devices (LVADs) have emerged as a critical alternative for patients with advanced HF. LVADs can serve as a bridge to transplantation or a long-term solution for that ineligible for a transplant. This systematic review and meta-analysis aims to evaluate the effectiveness and safety of LVADs, focusing on survival outcomes, adverse events, and quality of life.

Methods A comprehensive literature search was conducted across Cochrane Library, PubMed, and Google Scholar from 2000 to August 2025, adhering to PRISMA guidelines. The studies included were randomized controlled trials, cohort studies, and observational studies evaluating LVAD outcomes in patients with end-stage heart failure. Data on survival rates, adverse events, and quality of life were extracted and pooled for statistical analysis using the Restricted Maximum Likelihood (REML) model in Stata 18.0.

Results The pooled analysis showed that LVAD implantation improved survival and functional outcomes. Survival at 1 month post-implantation showed no significant improvement (odds-ratio [OR] = 0.06, 95% CI [−0.12, 0.23]), with low heterogeneity (I² = 0%, τ² = 0.00). At 2 months, the pooled OR was 0.09 (95% CI [−0.16, 0.34]) indicating no significant effect on survival. After 6 months, survival outcomes remained non-significant (OR = 0.12, 95% CI [−0.09, 0.33]). However, LVADs significantly improved functional capacity, with a 6-minute walk test (6MWT) showing a 74 ± 141 meter improvement (Starling et al., 2017). Adverse events, including bleeding,neurological issues, and thrombosis, were common. The risk of bleeding was significantly increased (risk-ratio [RR] = 1.87, 95% CI [0.94, 2.80]).

Conclusion LVADs are a valuable intervention for end-stage heart failure, offering substantial improvements in functional capacity and quality of life. While survival benefits were modest, the devices significantly enhance the well-being of patients ineligible for heart transplantation. However, the risks of adverse events remain, highlighting the need for careful management. Future advancements in LVAD technology are essential to optimize long-term outcomes and reduce complications, ensuring that LVADs remain a viable treatment option for patients with advanced heart failure.

The authors have declared no competing interest.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251133727

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