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DOI: 10.1055/s-0042-1742779
The HeartWare Ventricular Assist Device (HVAD): A Single Institutional 10-Year Experience
Funding None.![](https://www.thieme-connect.de/media/thoracic/202206/lookinside/thumbnails/10-1055-s-0042-1742779_216314oc-1.jpg)
Abstract
Objectives The aim of this study was to analyze our 10-year experience with the HVAD in a real-world scenario in a high-volume German heart center.
Methods We retrospectively analyzed outcomes of adults (≥18 years) with terminal heart failure (HF), who underwent HVAD implantation for durable LVAD therapy in our center between October 2009 and March 2020. Primary and secondary end points were all-cause death after implantation and LVAD-associated complications, respectively. We focused the distinct analyses on risk profiles at the time of implantation and implant strategies, i.e., bridge-to-transplant (BTT) or destination therapy (DT).
Results A total of 510 patients were included, with 229 and 281 individuals in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1 (45%) and 2 to 4, respectively. Median follow-up was 26 months (IQR: 5–54 months). Overall survival at 1, 3, and 5 years after HVAD implantation was 66% (95% CI; 61.7–70%), 49.4% (95% CI; 44.9–53.8%), and 37.4% (95% CI; 32.8–42%), not censored for LVAD exchange, LVAD explantation, or heart transplantation. INTERMACS level 1 and peri-operative temporary right heart assistance were independent risk factors for survival. Survival was best in BTT patients undergoing heart transplantation at any time during follow-up. The INTERMACS level at time of HVAD implantation did not affect survival after heart transplantation. Freedom from the combined end point of any device-associated severe complication and death was 44.5% (95% CI; 40–48.8%) at 1-year after implantation.
Conclusion The HVAD is a reliable pump for durable mechanical circulatory support even in high-risk patients. Still, heart transplantation outperforms durable MCS therapy for a superior long-term survival.
Keywords
left ventricular assist device - heart transplantation - survival - complications - HeartWare ventricular assist deviceAuthors' Contribution
T.G. did the conceptualization of the study, data retrieval, data analyses, and revision of the manuscript. S.V.R. contributed toward data analysis, writing, and revision of the manuscript. H.F. did the data retrieval, writing, and revision of the manuscript. M.-A.D. contributed toward data analysis, writing, and revision of the manuscript. M.R.C. worked upon data retrieval, data analysis, and revision of the manuscript. K.H.-M. did the data analysis and revised the manuscript. J.F.G. Conceptualized the study and revised the manuscript. M.M. contributed toward the conceptualization of the study, data retrieval, data analyses, writing and revision of the manuscript. R.S. did the conceptualization of the study, data retrieval, data analyses, writing and revision of the manuscript.
* These authors contributed equally.
Publication History
Received: 18 October 2021
Accepted: 15 December 2021
Article published online:
02 March 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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