Background: On June 3, 2021 Medtronic, Inc announced discontinuation of the HVAD left ventricular assist device. The purpose of this analysis was to provide summary data on surgical risks of HVAD to HeartMate 3 exchange and compare survival after HVAD to HeartMate 3 exchange to survival after primary HVAD implantation.
Methods: Three cohorts within The Society of Thoracic Surgeons Intermacs database were identified: primary HVAD implant cohort (January 2017 to March 2021, n = 3797), HVAD to HeartMate 3 exchange cohort (December 2017 to March 2021, n = 45), and HVAD to HVAD exchange cohort (January 2017 to March 2021, n = 234). Mortality after HVAD to HeartMate 3 exchange was modeled and compared with the constant hazard phase for risk of mortality while on continued HVAD support. As a secondary analysis outcomes and survival were compared between patients who underwent HVAD to HeartMate 3 and HVAD to HVAD exchange.
Results: HVAD to HeartMate 3 exchange was associated with significantly reduced survival compared with survival while remaining on HVAD support (6 months after exchange, 73.8% [70% confidence interval, 68.6-77.8] vs 79.0% [70% confidence interval, 78.3-79] for continued HVAD support). Compared with HVAD to HVAD exchange, survival was higher after replacement with HeartMate 3 (1 year: 85.9% [70% confidence interval, 79.5-90.5] vs 66.6% [70% confidence interval, 63.0-70.0], P = .009).
Conclusions: Compared with continued support on HVAD, an exchange to HeartMate 3 was found to be associated with a significant increase in mortality. For patients who required pump exchange on HVAD support, exchange to HeartMate 3 demonstrated superior survival. Currently there is insufficient evidence to support elective exchange from an HVAD to HeartMate 3.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.athoracsur.2021.09.031 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Echocardiographic Predictors of Ventricular Arrhythmias in Patients With Left Ventricular Assist Devices and Implantable Cardioverter-Defibrillator.
J Cardiovasc Electrophysiol
December 2024
Department of Cardiology, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
Aim: To evaluate the predictive value of preoperative echocardiographic parameters for occurrence of VAs in patients with preexisting ICD undergoing LVAD implantation.
Methods And Results: All consecutive patients (n = 264) with previous ICD who underwent LVAD surgery between May 2011 and December 2019 at our institution were included. The patients were predominantly male (89%) with NICM (59%) and a mean age of 59 ± 10 years.
Durable left ventricular assist devices following temporary circulatory support on a microaxial flow pump with and without extracorporeal life support.
JTCVS Open
October 2024
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany.
Background: Circulatory support with a catheter-based microaxial flow pump (mAFP) plays a major role in the treatment of severe cardiogenic shock. In most patients who fail to recover while on temporary mechanical circulatory support (tMCS) and who are not eligible for heart transplantation, durable left ventricular assist device (dLVAD) implantation is usually considered a reliable option. This study aimed to describe the outcome of dLVAD therapy following mAFP support and to identify predictors of mortality.
View Article and Find Full Text PDFNine Years of Continuous Flow LVAD (HeartMate 3): Survival and LVAD-Related Complications before and after Hospital Discharge.
J Cardiovasc Dev Dis
September 2024
Department of Thoracic and Cardiovascular Surgery, Tübingen University Hospital, 72076 Tübingen, Germany.
Background: End-stage heart failure is associated with high mortality. Recent developments such as the left ventricular assist device (LVAD) have improved patient outcomes. The HeartMate 3 LVAD is a novel centrifugal pump that was developed to provide hemodynamic support in heart failure patients, either as a bridge-to-transplant (BTT), myocardial recovery, or destination therapy (DT).
View Article and Find Full Text PDFPlatelet reactivity is associated with pump thrombosis in patients with left ventricular assist devices.
Res Pract Thromb Haemost
August 2024
Department of Internal Medicine I, Cardiology and Intensive Care Medicine, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.
Article Synopsis
- * In a study of 62 stable LVAD patients, 46.8% exhibited HRPR, which correlated with higher platelet aggregation and was noted to be significantly higher in patients suffering pump thrombosis.
- * The study concluded that HRPR could serve as an important risk indicator for pump thrombosis, especially among those with the HeartWare HVAD device.
Article Synopsis
- Right ventricular dysfunction (RVD) affects 30-40% of patients experiencing acute myocardial infarction and cardiogenic shock, leading to concerns about their survival outcomes when treated with left ventricular mechanical support.
- A study conducted across 80 sites analyzed 361 patients, finding that 28% had RVD, which correlated with lower survival rates to discharge (61.8% vs. 73.4%) and higher instances of severe shock and active CPR during treatment.
- Despite initial lower survival for RVD patients, hemodynamic parameters measured within 24 hours showed no significant differences between those with and without RVD, indicating that early left ventricular support may not immediately affect RV function.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!