Clinical experience with HeartWare left ventricular assist device in patients with end-stage heart failure

Challenging Treatment of an Infected CircuLite Synergy Micropump After Pump Thrombosis Due to Subtherapeutic Anticoagulation Therapy: Pushing the Limits?

“…To the Editor, As a response to the shortage of donor organs for heart transplantation (HTX), left ventricular assist device (LVAD) therapy has proven to be safe and efficient as a bridge to transplant for patients awaiting donor organs (1,2). Vast progress has been achieved in this field over the last few years, and new generations of small-size assist devices have become the standard of care for end-stage heart failure (HF).…”

HeartWare miniaturized intrapericardial ventricular assist device: advantages and adverse events in comparison to contemporary devices

“…• Despite excellent results and improved quality of life, perioperative complications, such as device thrombosis, bleeding, right heart failure, infections and aortic valve regurgitation, remain significant issues, which need to be addressed in the near future. • This report (with [44]) represents the largest single center experiences with the use of HVAD in patients with advanced heart failure. For personal use only.…”

“…The incidence of device thrombosis after HVAD implantation in the 23 patients in the first multicenter trial was 26% [8]. A subsequent change in the impeller manufacturing process, including adjustments of the thrust bearing dimensions, led to a significant reduction to 8% [8,9,44]. The main trigger for development of HVAD thrombosis, as for other CF LVADs, remains the subtherapeutic international normalized ratio, which should be maintained between 2 and 3.…”

“…Risk factors predictive of right-ventricular failure after LVAD implantation were reported in various studies and include greater preoperative presence of tricuspid valve regurgitation [58], central venous pressure:pulmonary capillary wedge pressure ratio more than 0.63, need for preoperative ventilator support and a blood-urea nitrogen level of >39 mg/dl [59], as well as preoperative need for intra-aortic balloon pump, increased PVR and destination therapy [60]. In HVAD, the overall event rate of RV failure requiring long-term intravenous inotropic support or short-term RVAD implantation amounts to 0.05-0.12 events per patient-year in multicenter trials [8,9] and 0.28-0.31 events per patient-year in single-center reports [44,58]. These results are comparable with other CF LVADs and superior to PF LVADs [3,12].…”

Organ donation following brain stem death after ventricular assist device implantation

“…Mechanical circulatory support for patients with advanced heart failure has evolved considerably during the past 30 years, and is now a standard therapy at many medical centers worldwide. 1 Ventricular assist devices have been mainly used as a bridge to transplantation, but as a result of donor shortage and the success of the newer devices, they are also considered as a bridge to recovery or a bridge to decision. 2…”