Trends in HeartMate 3: What we know so far

Lanfear, Allison T.; Hamandi, Mohanad; Fan, Joy; DiMaio, J. Michael; George, Timothy J.

doi:10.1111/jocs.14319

Cited by 9 publications

(15 citation statements)

References 42 publications

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“…Consistent with our study demonstrating higher LVAD use and acceptance among socioeconomically disadvantaged patients, the REVIVAL study has shown that there is a greater preference for LVAD devices among patients with high school education or less and those with an annual income less than $40,000 (9). The reasoning behind this decision making is complex and may reflect limited health literacy, lack of knowledge of alternative therapies, and ineligibility for heart transplantation (9,17).…”

Section: Discussionsupporting

confidence: 79%

“…When differentiating between patients eligible for transplantation versus alternative therapies, many patients with significant comorbidities are deemed ineligible for transplantation, leaving LVADs as one of the few advanced therapy options available (17). Previous studies indicate that individuals are more willing to receive an LVAD as the severity of their disease worsens and as their health-related quality of life diminishes.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Household Income In In-Hospital Outcomes After Implantation of Left Ventricular Assist Device

Ebner

Karetnick

Grant³

et al. 2021

Preprint

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Introduction: Due to the inability to keep up with the demand for heart transplantation, there is an increased utilization of left ventricular assist devices (LVAD). However, paucity of data exists regarding the association of household income with in-hospital outcomes after LVAD implantation. Methods: Retrospective cohort study using the NIS to identify all patients ≥18 years who underwent LVAD implantation from 2011-2017. Statistical analysis was performed comparing low household income (≤50th percentile) and high income (>50th percentile). Results: A total of 25,503 patients underwent LVAD implantation. The low-income group represented 53% and the high-income group corresponded to 47% of the entire cohort. The low-income group was found to be younger (mean age 55 ±14 vs. 58 ±14 years), higher proportion of females (24% vs. 22%), and higher proportion of blacks (32% vs. 16%, p<0.001 for all). The low-income group was found to have higher prevalence of hypertension, chronic pulmonary disease, smoking, dyslipidemia, obesity and pulmonary hypertension (p<0.001 for all). However, the high-income cohort had higher rate of atrial tachyarrhythmias and end-stage renal disease (p<0.001). During hospitalization, patients in the high-income group had increased rates of ischemic stroke, acute kidney injury, acute coronary syndrome, bleeding and need of extracorporeal membrane oxygenation (p<0.001 for all). We found that the unadjusted mortality had an OR 1.30 (CI [1.21-1.41], p<0.001) and adjusted mortality of OR 1.14 (CI [1.05-1.23], p=0.002). Conclusion: In patients undergoing LVAD implantation nationwide, low-income was associated with increased comorbidity burden, younger age, and fewer in-hospital complications and all-cause mortality.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Comparison of Household Income In In-Hospital Outcomes After Implantation of Left Ventricular Assist Device

Ebner

Karetnick

Grant³

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…9 The reasoning behind this decision making is complex and may reflect limited health literacy, lack of knowledge of alternative therapies, and ineligibility for heart transplantation. 9,17 The National Survey of Families and Households, the Survey of Income and Program Participation, and the National Health Interview Survey represent the keystone of information necessary to study the link between income and health. Researchers have long noted a positive correlation between wealth and longevity, with higher income individuals having greater life expectancy compared to low-income counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…3,21 When differentiating between patients eligible for transplantation versus alternative therapies, many patients with significant comorbidities are deemed ineligible for transplantation, leaving LVADs as one of the few advanced therapy options available. 17 Previous studies indicate that individuals are more willing to receive an LVAD as the severity of their disease worsens and as their health-related quality of life diminishes. Furthermore, many wealthy individuals have at least one contraindication to heart transplantation often stemming from chronic diseases and ailments such as pulmonary hypertension and advanced age.…”

Section: Discussionmentioning

confidence: 99%

Comparison of household income in in-hospital outcomes after implantation of left ventricular assist device

et al. 2021

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Introduction: Due to the inability to keep up with the demand for heart transplantation, there is an increased utilization of left ventricular assist devices (LVAD). However, paucity of data exists regarding the association of household income with in-hospital outcomes after LVAD implantation. Methods: Retrospective cohort study using the NIS to identify all patients ⩾18 years who underwent LVAD implantation from 2011 to 2017. Statistical analysis was performed comparing low household income (⩽50th percentile) and high income (>50th percentile). Results: A total of 25,503 patients underwent LVAD implantation. The low-income group represented 53% and the high-income group corresponded to 47% of the entire cohort. The low-income group was found to be younger (mean age 55 ± 14 vs 58 ± 14 years), higher proportion of females (24% vs 22%), and higher proportion of blacks (32% vs 16%, p < 0.001 for all). The low-income group was found to have higher prevalence of hypertension, chronic pulmonary disease, smoking, dyslipidemia, obesity, and pulmonary hypertension ( p < 0.001 for all). However, the high-income cohort had higher rate of atrial tachyarrhythmias and end-stage renal disease ( p < 0.001). During hospitalization, patients in the high-income group had increased rates of ischemic stroke, acute kidney injury, acute coronary syndrome, bleeding, and need of extracorporeal membrane oxygenation ( p < 0.001 for all). We found that the unadjusted mortality had an OR 1.30 (CI 1.21–1.41, p < 0.001) and adjusted mortality of OR 1.14 (CI 1.05–1.23, p = 0.002). Conclusion: In patients undergoing LVAD implantation nationwide, low-income was associated with increased comorbidity burden, younger age, and fewer in-hospital complications and all-cause mortality.

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“…With the new United Network for Organ Sharing guidelines giving lower priority to patients with continuous-flow LVADs than in the previous schema, it is likely that LVADs will be used for long-term support irrespective of transplant eligibility [ 1 ]. Given this need to increase device longevity, coupled with a growing interest in minimally invasive intrapleural LVAD placement [ 2 , 3 ], whereby pumps must be placed into the pleural space, it is necessary to develop a more thorough understanding of optimal LVAD placement methods.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes

et al. 2022

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Background The integrated design of the HeartMate 3 (Abbott Laboratories, Chicago, IL, USA) affords flexibility to place the pump within the pericardium or thoracic cavity. We sought to determine whether the presence of a left ventricular assist device (LVAD) in either location has a meaningful impact on overall patient outcomes. Methods A retrospective cohort study was conducted of all 165 patients who received a HeartMate 3 LVAD via a median sternotomy from November 2014 to August 2019 at our center. Based on operative reports and imaging, patients were divided into intrapleural (n=81) and intrapericardial (n=84) cohorts. The primary outcome of interest was in-hospital mortality, while secondary outcomes included postoperative complications, cumulative readmission incidence, and 3-year survival. Results There were no significant between-group differences in baseline demographics, risk factors, or preoperative hemodynamics. The overall in-hospital mortality rate was 6%, with no significant difference between the cohorts (9% vs. 4%, p=0.20). There were no significant differences in the postoperative rates of right ventricular failure, kidney failure requiring hemodialysis, stroke, tracheostomy, or arrhythmias. Over 3 years, despite similar mortality rates, intrapleural patients had significantly more readmissions (n=180 vs. n=117, p<0.01) with the most common reason being infection (n=68/165), predominantly unrelated to the device. Intrapleural patients had significantly more infection-related readmissions, predominantly driven by non-ventricular assist device-related infections (p=0.02), with 41% of these due to respiratory infections compared with 28% of intrapericardial patients. Conclusion Compared with intrapericardial placement, insertion of an intrapleural HM3 may be associated with a higher incidence of readmission, especially due to respiratory infection.

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Trends in HeartMate 3: What we know so far

Cited by 9 publications

References 42 publications

Comparison of Household Income In In-Hospital Outcomes After Implantation of Left Ventricular Assist Device

Comparison of Household Income In In-Hospital Outcomes After Implantation of Left Ventricular Assist Device

Comparison of household income in in-hospital outcomes after implantation of left ventricular assist device

The Impact of Intrapericardial versus Intrapleural HeartMate 3 Pump Placement on Clinical Outcomes

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