Third‐generation continuous‐flow left ventricular assist devices: a comparative outcome analysis by device type
Abstract 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 Investigat...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13794 |
| _version_ | 1797794313199943680 |
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| author | Maks Mihalj Paul Philipp Heinisch Patrick Schober Monika Wieser Michele Martinelli Theo M.M.H. deBy Joerg C. Schefold Markus M. Luedi Alexander Kadner Thierry Carrel Paul Mohacsi Lukas Hunziker David Reineke |
| author_facet | Maks Mihalj Paul Philipp Heinisch Patrick Schober Monika Wieser Michele Martinelli Theo M.M.H. deBy Joerg C. Schefold Markus M. Luedi Alexander Kadner Thierry Carrel Paul Mohacsi Lukas Hunziker David Reineke |
| author_sort | Maks Mihalj |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-13T03:00:54Z |
| format | Article |
| id | doaj.art-b50806095724430599967ea028403776 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-13T03:00:54Z |
| publishDate | 2022-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-b50806095724430599967ea0284037762023-06-27T14:49:57ZengWileyESC Heart Failure2055-58222022-10-01953469348210.1002/ehf2.13794Third‐generation continuous‐flow left ventricular assist devices: a comparative outcome analysis by device typeMaks Mihalj0Paul Philipp Heinisch1Patrick Schober2Monika Wieser3Michele Martinelli4Theo M.M.H. deBy5Joerg C. Schefold6Markus M. Luedi7Alexander Kadner8Thierry Carrel9Paul Mohacsi10Lukas Hunziker11David Reineke12Department of Cardiovascular Surgery Bern University Hospital, University of Bern Bern SwitzerlandDepartment of Cardiovascular Surgery Bern University Hospital, University of Bern Bern SwitzerlandDepartment of Anesthesiology Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The NetherlandsDepartment of Cardiology Bern University Hospital, University of Bern Bern SwitzerlandDepartment of Cardiology Bern University Hospital, University of Bern Bern SwitzerlandEUROMACS, European Association for Cardio‐Thoracic Surgery (EACTS) Windsor UKDepartment of Intensive Care Medicine Bern University Hospital, University of Bern Bern SwitzerlandDepartment of Anesthesiology and Pain Medicine Bern University Hospital, University of Bern Bern SwitzerlandDepartment of Cardiovascular Surgery Bern University Hospital, University of Bern Bern SwitzerlandDepartment of Cardiovascular Surgery Bern University Hospital, University of Bern Bern SwitzerlandDepartment of Cardiology Bern University Hospital, University of Bern Bern SwitzerlandDepartment of Cardiology Bern University Hospital, University of Bern Bern SwitzerlandDepartment of Cardiovascular Surgery Bern University Hospital, University of Bern Bern SwitzerlandAbstract 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.https://doi.org/10.1002/ehf2.13794Left ventricular assist deviceLVADHeartMate3HeartWare HVADOutcome comparison |
| spellingShingle | Maks Mihalj Paul Philipp Heinisch Patrick Schober Monika Wieser Michele Martinelli Theo M.M.H. deBy Joerg C. Schefold Markus M. Luedi Alexander Kadner Thierry Carrel Paul Mohacsi Lukas Hunziker David Reineke Third‐generation continuous‐flow left ventricular assist devices: a comparative outcome analysis by device type ESC Heart Failure Left ventricular assist device LVAD HeartMate3 HeartWare HVAD Outcome comparison |
| title | Third‐generation continuous‐flow left ventricular assist devices: a comparative outcome analysis by device type |
| title_full | Third‐generation continuous‐flow left ventricular assist devices: a comparative outcome analysis by device type |
| title_fullStr | Third‐generation continuous‐flow left ventricular assist devices: a comparative outcome analysis by device type |
| title_full_unstemmed | Third‐generation continuous‐flow left ventricular assist devices: a comparative outcome analysis by device type |
| title_short | Third‐generation continuous‐flow left ventricular assist devices: a comparative outcome analysis by device type |
| title_sort | third generation continuous flow left ventricular assist devices a comparative outcome analysis by device type |
| topic | Left ventricular assist device LVAD HeartMate3 HeartWare HVAD Outcome comparison |
| url | https://doi.org/10.1002/ehf2.13794 |
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