Off-Pump HeartWare HVAD Left Ventricular Assist Device Implantation

Objectives: Left ventricular assist devices (LVAD) are routinely implanted with cardiopulmonary bypass support. Patients with terminal heart failure are typically multimorbid and might therefore profit from a less invasive implant technique with avoidance of cardiopulmonary bypass. We report our experience with off-pump Heartware HVAD LVAD implantation.

Methods: We retrospectively reviewed data of 19 patients who underwent off-pump Heartware HVAD implantation from November 2012 to June 2015. Study endpoints were patient demographics, operative outcome, long-term survival and incidence of adverse events.

Results: Mean patient age was 61 ± 9yrs., 89.5% were male and underlying disease was of ischemic origin in 47.4%. Intermacs Levels at the time of HVAD Implantation were: Level I: 15.8%, Level II: 5.3%, Level III: 42.1%, Level 4: 36.8%. Implant strategies were Bridge to Transplantation (5.3%), Destination Therapy (31.6%) or Bridge to Candidacy (63.2%), respectively. Mean duration of support was 478 ± 269 days (range 31–1105). The off-pump procedure was feasible in all patients with no on-pump conversions. We observed no perioperative stroke and only two surgical bleedings (15.4%). Both of which required surgical revision due to hematothorax and resulted in complete recovery. 30-day and in-hospital mortality rates were 0% and 5.3%, respectively. One-year-survival was 84.2%.

Conclusion: Our preliminary experience shows that off-pump Heartware HVAD implantation is a feasible and safe alternative to the standard implantation technique that is especially appealing in multimorbid high-risk patients.