Comparing short‐term outcome after implantation of the HeartWare® HVAD® and the Abbott® HeartMate 3®

Abstract

Aims Centrifugal continuous flow pumps are currently the state of the art in left ventricular assist device therapy. This study was conducted to compare the results after implantation of the HVAD® and the HeartMate 3®. Methods and results We retrospectively analysed preoperative and post-operative patient data of all 106 patients, who received a HeartMate 3 (HM3) at our centre between 2014 and 2018. A total of 392 patients receiving a sintered HVAD® served as controls. Patient matching was performed for age, sex, Interagency Registry for Mechanically Assisted Circulatory Support level at the time of implant, perioperative right heart failure, and implantation strategy, that is, bridge to transplant or destination therapy, as well as preoperative renal function, that is, as indicated by serum creatinine levels. A total of 79 matched pairs could be identified. During a median follow-up of 15.3 months (range: 0-30 months), 23 (29.1%) and 19 (24.1%) patients died in the HVAD and HM3 groups, respectively, with a hazard ratio for mortality of 0.84 [95% confidence interval (CI): 0.46-1.54; P = 0.568]. Freedom from cerebrovascular events did not differ significantly between study groups, with a hazard ratio of 0.57 (95% CI: 0.23-1.45; P = 0.241). The risk of driveline infection was significantly lower in the HM3 (n = 33) than in the HVAD (n = 55) group (hazard ratio = 0.54; 95% CI: 0.35-0.84; P = 0.006). Eight HVAD, but no HM3, patients developed a pump thrombosis during follow-up (P = 0.148). Conclusions Performance of both currently used centrifugal left ventricular assist device systems is comparable in terms of short-term patient survival and freedom from cerebrovascular events. In our single-centre experience, HM3 patients less frequently develop driveline infections and no pump thrombosis, which requires further evaluation.

Identification of characteristics, risk factors, and predictors of recurrent LVAD thrombosis: conditions in HeartWare devices

“…All four patients had heart transplantation subsequently without major complication. According to recently published data by Schramm et al, the HeartMate 3 (Abbott, Abbott Park, IL, USA) has very low risk of LVAD thrombosis, which one could consider in case of recurrent LVAD thrombosis change the device into HeartMate 3 [19,20].…”

Durable Continuous-Flow Mechanical Circulatory Support: State of the Art

“…In recent years, the majority of patients treated with a long-term LVAD received a CF system, i.e., a radial pump such as the HeartWare HVAD (Medtronic), or an axial-flow pump such as the HeartMate II (Abbott) [5][6][7][8][9][10][11][12][13][14][15]. Recently, a new generation of magnetically levitated radial pumps (HeartMate 3; Abbott) received Conformité Européenne (CE) approval and became available in Europe [5,[16][17][18][19][20][21]. Generally, these pumps unload the heart by pumping blood from the left ventricle to the ascending aorta [7,9,11,12].…”

“…Devices have been developed by WorldHeart, Terumo, Medtronic (HeartWare), and Abbott (Thoratec) that have either received CE approval in Europe or FDA approval in the USA for short-to longterm usage, based on clinical trials. HeartWare HVAD (Medtronic) and HeartMate 3 (Abbott) are being used increasingly often, with implantations performed using these devices already surpassing those using all previous rotary devices [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]23,24].…”

“…The HeartMate 3 (Abbott) is a new radial-flow LVAD (Figure 1) that is intended to provide full hemodynamic support to patients with advanced HF [5][6][7][8][9][10][11][12][16][17][18][19][20][21]. The device is manufactured for the intrapericardial position, with the inflow cannula inserted into the left ventricle and the outflow graft anastomosed to the ascending aorta.…”

Assist-Devices bei terminaler Herzinsuffizienz

“…Die Neuentwicklung eines artifiziellen Pulsmodus im HeartMate 3 bringt in dieser Hinsicht allerdings keinen wesentlichen Vorteil [19]. Hingegen scheint das Risiko für zerebrale Infarkte beim HeartMate 3 im Vergleich zum HeartMate II niedriger zu sein [13], auch wenn einige retrospektive Studien keine signifikanten Unterschiede zeigen konnten [20]. Innerhalb der ersten beiden Jahre nach LVAD-Implantation ist das Schlaganfallrisiko mit bis zu 20 % jedoch weiterhin präsent, wobei die klinische Ausprägung natürlich variabel sein kann und von einer transitorisch-ischämischen Attacke (TIA) bis zu einem lebensbedrohlichen Schlaganfall, auch inklusive einer Blutung, reicht.…”