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

• DOI: 10.1002/ehf2.13794
• Publication Date: 2022-07-26T08:45:40Z
• Authors: Maks Mihalj; Paul Philipp Hein...; Patrick Schober; Monika Wieser; Michele Martinelli; Theo M.M.H. de By; Joerg C. Schefold; Markus M. Luedi; Alexander Kadner; Thierry Carrel; Paul Mohacsi; Lukas Hunziker; David Reineke
• Keywords: Interquartile range; Destination therapy; Clinical endpoint

Continuous-flow left ventricular assist devices (CF-LVADs) have become a standard of care in end-stage heart failure. Limited data exist comparing outcomes HeartMate3 (HM3) and HeartWare HVAD (HW). We aimed to compare midterm these devices.Investigator-initiated retrospective-observational comparative analysis all patients who underwent primary LVAD implantation either HM3 or HW at our centre between January 2010 December 2020. Data were derived from prospective registry. Primary endpoints all-cause mortality transplantation. Secondary included device-related major adverse cardiac cerebrovascular events, which bleeding, neurological dysfunction (defined as persisting impairment for ≥24 h), infection (excluding driveline infections), device malfunctions leading re-intervention partial exchange (pump failure, outflow-graft twist controller battery patient cable but excluding pump thrombosis), thrombosis. Further secondary right gastrointestinal infections, surgical re-interventions. The analysed not only the first event also recurrent events. competing risks regression analysis, with adjustment confounders age, gender, body mass index (BMI), Interagency Registry Mechanically Assisted Circulatory Support (INTERMACS) level. Out 106 CF-LVAD implantations, 36 (34%) received 70 (66%) HW. Median follow-up was 1.48 years [interquartile range 0.67, 2.41]. more often implanted men (91.7% vs. 72.9%, P = 0.024); older (median 61 [54, 66.5] 52.5 [43, 60], < 0.001), had higher BMI 26.7 kg/m2 [23.4, 29.0] 24.3 [20.7, 27.4], 0.013), comorbidities, likely targeted destination therapy (36.1% 14.3%, 0.010). Death occurred 33.3% patients, compared 22.9% 0.247 (probability survival 4 years, 54.7% 74.1%, 0.296). After confounders, we observed significant six-fold risk increase [hazard ratio (HR) 6.49, 95% confidence interval (CI) [1.89, 22.32], 0.003], no differences thrombosis (P 0.173) overall 0.801).Comparing support registry, significantly malfunctions. No evident respect most outcomes.