Outcomes and Readmissions After Continuous Flow Left Ventricular Assist Device: Heartmate II Versus Heartware Ventricular Assist Device

Tuncer, Osman Nuri; Kemaloğlu, Cemal; Erbasan, Ozan; Golbasi, Ilhan; Türkay, Cengiz; Bayezid, Ömer

doi:10.1016/j.transproceed.2016.03.056

Cited by 15 publications

(7 citation statements)

References 17 publications

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“…In our study, the incidence of severe pump infections that required surgical treatment was significantly higher in HMII recipients than in HeartWare HVAD recipients (50% vs 23%; P = 0.04). Our findings support those of other published reports of infection rates in LVAD recipients …”

Section: Discussionsupporting

confidence: 93%

Severe LVAD-related infections requiring surgical treatment: Incidence, predictors, effect on survival, and impact of device selection

et al. 2019

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Background Left ventricular assist devices (LVADs) are being used more frequently for treating refractory, advanced heart failure. However, infection remains a frequent complication. In this study, we analyzed the incidence of severe infections in LVAD recipients to determine its impact on survival. Methods From May 2009 through March 2016, 437 patients with advanced heart failure underwent implantation of a continuous‐flow LVAD (n = 314, HeartMate II LVAD [Abbott Laboratories, Abbott Park, IL]; n = 123 HeartWare HVAD [Medtronic, Minneapolis, MN]). We analyzed the rate of severe device infection requiring surgical intervention or involving sepsis and the impact of severe infection on outcomes in patients on long‐term LVAD support. Results Infection occurred in 244 patients (HeartMate II, n = 186; HVAD, n = 58); severe infections developed in 160 patients (HeartMate II, n = 119; HVAD, n = 41). HeartMate II recipients had 344 severe infection events (0.63 events per patient‐year [EPPY]), whereas HeartWare recipients had 89 severe infection events (0.42 EPPY; P = 0.047). HeartMate II recipients had a higher incidence of pump infections (P < 0.001). Severe infections did not significantly affect survival (P = 0.42). Conclusions Although HeartMate II patients had a significantly higher incidence of pump infections requiring surgical treatment, survival was not adversely affected. The difference in postoperative infection rates may be an important factor in device type selection.

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Section: Discussionsupporting

confidence: 93%

Severe LVAD-related infections requiring surgical treatment: Incidence, predictors, effect on survival, and impact of device selection

et al. 2019

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“…24,25 This is supported by recent studies that found the polyurethane HVAD driveline had a lower incidence of infection compared with silicone-based drivelines used by other VAD systems, such as the HeartMate II (St Jude, Pleasanton, Calif), although other factors such as the size of drivelines might have played a role. 26,27 However, despite the HeartWare's anti-infective effort by using polyurethane and polystyrene for driveline manufacturing, our Adding velour to the driveline to enhance its tissue interaction and stability has been widely adopted by VAD manufacturers. We dissected the driveline velour after microorganism inoculation and found that microorganisms colonized the entire 3-dimensional network structure.…”

Section: Discussionmentioning

confidence: 99%

Biofilm formation and migration on ventricular assist device drivelines

McGiffin

Kure

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: Driveline infections remain an important complication of ventricular assist device therapy, with biofilm formation being a major contributor. This study aimed to elucidate factors that govern biofilm formation and migration on clinically relevant ventricular assist device drivelines.Methods: Experimental analyses were performed on HeartWare HVAD (Heart-Ware International Inc, Framingham, Mass) drivelines to assess surface chemistry and biofilm formation. To mimic the driveline exit site, a drip-flow biofilm reactor assay was used. To mimic a subcutaneous tissue environment, a tunnel-based interstitial biofilm assay was developed. Clinical HVAD drivelines explanted at the time of cardiac transplantation were also examined by scanning electron microscopy.Results: Common causative pathogens of driveline infections were able to adhere to the smooth and velour sections of the HVAD driveline and formed robust biofilms in the drip-flow biofilm reactor; however, Pseudomonas aeruginosa and Candida albicans had greater biomass. Biofilm migration within the interstitial driveline tunnel was evident for Staphylococcus epidermidis, Staphylococcus aureus, and C albicans, but not P aeruginosa. Biofilm formation by staphylococci was 500 to 10,000 times higher in the tunnel-based model compared with our exit site model. The 3-dimensional structure of the driveline velour and the use of silicone adhesive in driveline manufacturing were found to promote biofilm growth, and explanted patient drivelines demonstrated inadequate tissue in-growth along the entire velour with micro-gaps between velour fibers.Conclusions: This work highlights the predilection of pathogens to different parts of the driveline, the importance of the subcutaneous tunnel to biofilm formation and migration, and the presence of micro-gaps in clinical drivelines that could facilitate invasive driveline infections.

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“…1 Mortality after inpatient admission for HF has been estimated to be as great as 35% within 1 year and 75% within 5 years. 2 HF leads federal funding mandates, and a disproportionate amount of resources are aimed at the management of advanced HF. With the combination of an aging population and increasing burden of ischemic heart disease, the prevalence of end-stage HF continues to rise.…”

Section: Introductionmentioning

confidence: 99%

Readmission and resource utilization after orthotopic heart transplant versus ventricular assist device in the National Readmissions Database, 2010–2014

Mukdad

Mantha

Aguayo

et al. 2018

Surgery

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Readmission rates and costs for patients with a ventricular assist device remain greater than their orthotopic heart transplantation counterparts. Given the projected increases in ventricular assist device utilization and limited transplant donor pool, further emphasis on cost containment and decreased readmissions for patients undergoing a ventricular assist device is essential to the viability of such therapy in the era of value-based health care delivery.

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Outcomes and Readmissions After Continuous Flow Left Ventricular Assist Device: Heartmate II Versus Heartware Ventricular Assist Device

Cited by 15 publications

References 17 publications

Severe LVAD-related infections requiring surgical treatment: Incidence, predictors, effect on survival, and impact of device selection

Severe LVAD-related infections requiring surgical treatment: Incidence, predictors, effect on survival, and impact of device selection

Biofilm formation and migration on ventricular assist device drivelines

Readmission and resource utilization after orthotopic heart transplant versus ventricular assist device in the National Readmissions Database, 2010–2014

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