Clinical Outcome and Comparison of Three Different Left Ventricular Assist Devices in a High‐Risk Cohort

Abstract

We present a comparison between three left ventricular assist devices (LVADs): HeartWare (HVAD) (HeartWare International Inc., Framingham, MA, USA), HeartMate II (HMII) and HeartMate III (HMIII) (Thoratec Corp., Pleasanton, CA, USA). To our knowledge, no study to date has aimed at placing these three devices in juxtaposition. Between June 2007 and June 2017, 108 consecutive patients received HMII, n = 77 (71.3%), HVAD, n = 14 (13%), or HM III, n = 17 (15.7%), for end-stage heart failure. Mean age was 63.8 ± 11.2 years (range 24-84 years), with median INTERMACS profile of 3. Preoperatively, 26 patients (24.1%) were ventilated, 17 patients (15.7%) had an intraaortic balloon pump, and 27 patients (25%) were on extracorporeal life support. Overall survival at 30 days was 70.4%, at 1 year 51.9%, and at 5 years 38% with no significant difference in survival between HMII, HVAD, and HMIII. Median cardiopulmonary bypass time was 113 min (range 50-371 min). Two patients received a minimally-invasive procedure. Most common adverse events were revision for bleeding (42.6%), tracheotomy (33.3%), acute kidney failure with new-onset dialysis (25%), sepsis (17.6%), and gastrointestinal bleeding (10.2%). The average duration of follow-up was 1.52 ± 2.11 years (range 0-7.95 years). The median number of readmissions was 2 (range 0-23), the median length of hospital stay as readmission was 17 days (range 0-158 days). Strong predictors of overall mortality (P < 0.05) were postoperative sepsis (OR = 5.729, 95%CI = 3.001-10.937), intraoperative/postoperative need for right ventricular mechanical support (OR = 5.232, 95%CI = 3.008-9.102), preoperative extracorporeal life support (OR = 2.980, 95%CI = 1.615-5.500), readmission because of suboptimal INR value (OR = 2.748, 95%CI = 1.045-7.226), need of inotropes over 7 days postoperatively (OR = 2.556, 95%CI = 1.432-4.562), new onset of temporary hemodialysis postoperatively (OR = 1.986, 95%CI = 1.084-3.635), and female gender (OR = 1.955, 95%CI = 1.062-3.598). No significant difference in mortality between HMII, HVAD, and HMIII was observed. The following predictors of overall mortality were identified (P < 0.05): postoperative sepsis, need for perioperative mechanical support, readmission because of suboptimal INR value, new onset of temporary hemodialysis postoperatively and female gender.

Impact of preoperative extracorporeal life support on left ventricular assist device outcomes: A comparative study

“…This limiting factor might be potentially a source of criticism. However, as previously published by our group, 14 the device implanted in the examined cohort had no significant effect on the outcome.…”

Artificial Organs 2018: A Year in Review

“…Konstantin Zhigalov et al of the Carl von Ossietzky University, Oldenburg, Germany, compared clinical outcomes of three different left ventricular assist devices (VAD), HeartWare (HVAD, n = 14), HeartMate II (HMII, n = 77), and HeartMate III (HMIII, n = 17). Overall survival at 30 days was 70.4%, at 1 year 51.9%, and at 5 years 38% with no significant difference in survival between the devices.…”

Detection of thrombosis in a magnetically levitated blood pump by vibrational excitation of the impeller

“…The development of contactless support technologies for the impeller has led to an increase in the durability of ventricular assist devices (VADs). Such VADs utilize the hydrodynamic bearings, for example, HVAD (Medtronic Inc., Minneapolis, MN, USA), or magnetic bearings, for example, HeartMate 3 (Abbott Laboratories, Chicago, IL, USA), for levitation of the impeller and have been in clinical use worldwide . Although much technical progress has been made in VADs, pump thrombosis and stroke are still serious issues in this field .…”