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

Abstract

Increasing incidence of end-stage heart failure and limited availability of donor organs have led to longer waiting times for cardiac transplantation and subsequently increasing mortality. Ventricular assist device therapy is fast becoming an accepted alternative treatment to treat end-stage heart failure and is being implemented as a bridge to decision, bridge to myocardial recovery, bridge to heart transplantation or as a destination therapy. LVADs not only enable hemodynamic stabilization and recovery of secondary organ failure in severely ill patients, but have also been shown to reduce pulmonary vascular resistance in nontransplantable candidates. Technology of ventricular assist devices has evolved over several decades of time and generations of devices. The HVAD® Pump (HeartWare International, Inc., MA, USA) is a third-generation, miniaturized, continuous-flow ventricular assist device. Due to its miniaturized housing and intrapericardial placing, it can be used proficiently to support the right ventricle and has also demonstrated great utility in minimally invasive and off-pump implantation, exchange and explantation. It is favored for similar reasons in adolescents and in heart failure due to complex congenital heart disease. The purpose of this article is to review the clinical use of HeartWare® Ventricular Assist System (HeartWare System; HeartWare International, Inc.) with different strategies pertaining to its advantages and adverse events in comparison with contemporary devices.

Continuous-Flow Left Ventricular Assist Device Therapy in Patients With Preoperative Hepatic Failure: Are We Pushing the Limits Too Far?

“…Deranged metabolic function of the liver can be assessed by increased bilirubin levels, whereas a deranged hepatic synthetic mechanism is reflected in terms of hypoalbuminemia and coagulopathy. Whereas cf‐LVADs can sustainably improve recovery of end‐organ function , significant preoperative hepatic dysfunction or failure may be detrimental following cf‐LVAD implantation, particularly as part of a destination‐therapy strategy , leading to significant morbidity and mortality.…”

First Experience With the Synergy Micro‐Pump in Patients in INTERMACS Class 1–2 as a Bridge to Transplantation: Pushing the Limits?

“…The surgical implantation technique was performed as described previously , although with minor changes. In brief, a 4‐cm subclavicular incision was made, and the right subclavian artery was dissected.…”

“…This problem could be partially resolved by more widespread adoption of ventricular assist devices (VADs), which are becoming established therapies for bridge to transplantation, bridge to recovery, and chronic support . In the last two decades, rapid technological development in VADs has led to clinical implementation of smaller, quieter, and more durable second‐ and third‐generation continuous‐flow devices, which are now increasingly used to support patients with end‐stage heart failure . Nevertheless, despite improving clinical outcomes and quality of life compared with previous generations of VADs, these full‐support devices are still associated with median sternotomy, and the implantation of these devices remains in most cases a major surgical procedure necessitating cardiopulmonary bypass (CPB), leading to a significant morbidity and mortality .…”

Successful bridge to recovery using two-stage HeartWare LVAD explantation approach after embolic stroke

“…One of the most significant design advantages of the HeartWare HVAD Pump is its size, intrapericardial placement and versatility in terms of implant options [4]. Due to the miniaturized dimensions it can be implanted over a minimal invasive approach without sternotomy [5].…”