Third-generation continuous-flow left ventricular assist devices: a comparative outcome analysis by device type.

Mihalj, Maks; Heinisch, Paul Philipp; Schober, Patrick; Wieser, Monika; Martinelli, Michele; de By, Theo M M H; Schefold, Joerg C; Luedi, Markus M; Kadner, Alexander; Carrel, Thierry; Mohacsi, Paul; Hunziker, Lukas; Reineke, David (2022). Third-generation continuous-flow left ventricular assist devices: a comparative outcome analysis by device type. ESC Heart Failure, 9(5), pp. 3469-3482. Wiley 10.1002/ehf2.13794

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AIMS

Continuous-flow left ventricular assist devices (CF-LVADs) have become a standard of care in end-stage heart failure. Limited data exist comparing outcomes of HeartMate3 (HM3) and HeartWare HVAD (HW). We aimed to compare midterm outcomes of these devices.

METHODS AND RESULTS

Investigator-initiated retrospective-observational comparative analysis of all patients who underwent primary LVAD implantation of either HM3 or HW at our centre between January 2010 and December 2020. Data were derived from a prospective registry. Primary endpoints were all-cause mortality and heart transplantation. Secondary endpoints included device-related major adverse cardiac and cerebrovascular events, which included major bleeding, major neurological dysfunction (defined as persisting neurological impairment for ≥24 h), device-related major infection (excluding driveline infections), major device malfunctions leading to re-intervention or partial device exchange (pump failure, outflow-graft twist or failure, controller failure, battery failure, patient cable failure, but excluding pump thrombosis), and pump thrombosis. Further secondary endpoints included right heart failure, gastrointestinal bleeding, driveline infections, and surgical re-interventions. The secondary outcomes were analysed not only for the first event but also for recurrent events. The analysis included competing risks analysis and recurrent event regression analysis, with adjustment for confounders age, gender, body mass index (BMI), and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level. Out of 106 primary CF-LVAD implantations, 36 (34%) received HM3 and 70 (66%) received HW. Median follow-up was 1.48 years [interquartile range 0.67, 2.41]. HM3 was more often implanted in men (91.7% vs. 72.9%, P = 0.024); patients were older (median 61 years [54, 66.5] vs. 52.5 years [43, 60], P < 0.001), had a higher BMI (median 26.7 kg/m2 [23.4, 29.0] vs. 24.3 kg/m2 [20.7, 27.4], P = 0.013), had more comorbidities, and were more likely targeted for destination therapy (36.1% vs. 14.3%, P = 0.010). Death occurred in 33.3% of HM3 patients, compared with 22.9% of HW patients, P = 0.247 (probability of survival at 4 years, 54.7% vs. 74.1%, P = 0.296). After adjustment for confounders, we observed a significant six-fold risk increase in device malfunctions for HW [hazard ratio (HR) 6.49, 95% confidence interval (CI) [1.89, 22.32], P = 0.003], but no significant differences in pump thrombosis (P = 0.173) or overall survival (P = 0.801).

CONCLUSIONS

Comparing midterm outcomes between HM3 and HW for LVAD support from a prospective registry, HW patients had a significantly higher risk of device malfunctions. No significant differences were evident between devices in overall survival and in respect to most outcomes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Mihalj, Maks; Heinisch, Paul Philipp; Wieser, Monika; Martinelli, Michele; Schefold, Jörg Christian; Lüdi, Markus; Kadner, Alexander; Carrel, Thierry; Mohacsi, Paul; Hunziker Munsch, Lukas Christoph and Reineke, David Christian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2055-5822

Publisher:

Wiley

Language:

English

Submitter:

Pubmed Import

Date Deposited:

27 Jul 2022 09:36

Last Modified:

05 Dec 2022 16:22

Publisher DOI:

10.1002/ehf2.13794

PubMed ID:

35880515

Uncontrolled Keywords:

HeartMate3 HeartWare HVAD LVAD Left ventricular assist device Outcome comparison

BORIS DOI:

10.48350/171571

URI:

https://boris.unibe.ch/id/eprint/171571

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