Complications following Left Ventricular Assist Device Implantation—Comparison of HeartWare and HeartMate III: A Single-Center 5-Year Experience

Objectives: Left ventricular assist devices (LVADs) are now a mainstay in the treatment of terminal heart failure. The aim of our study was to analyze postoperative short-term (30 days) and long-term complications (up to 5 years) and to compare the occurrence of complications with regard to the implanted devices (HeartWare [HW] vs. HeartMate III [HMIII]).

Methods: We reviewed 45 consecutive patients who underwent LVAD implantation at our institution from January 2014 to January 2019. The decision concerning choice of the LVAD implanted was made by the operating surgeon prior to the procedure. Data was collected as part of the clinical routine and are presented as medians and 25th–75th percentiles, or absolute numbers and percentages.

Results: The median age was 61 (54–66) years. A total of 42 (93.3%) patients received LVADs as bridge to destination, whereas 4 (8.9%) of the patients received LVADs as bridge to transplant. We implanted 28 (62.2%) HW and 17 (37.8%) HM III assist devices. The median survival time was 537 (220–1,171) days. HM III and HW patients showed no significant differences in their preoperative comorbidities. Concerning short-term follow-up, 30-day mortality was 13.3%. There were no differences between the patients concerning the incidence of in-hospital complications, i.e., adverse cerebrovascular events (CVE; 4.4%), right ventricular failure (13.3%), bleeding (44.4%), and pneumonia (15.6%). However, in long-term follow-up, patients in the HM III group showed a significantly higher incidence of driveline infections (HM III: 47.1 vs. HW: 10.7%, p = 0.007) and a higher, although not statistically significant, rate of CVE (HM III: 41.2% vs. HW: 17.9%; p = 0.090). No differences were observed regarding pump thrombosis (HM III: 11.8% vs. HW: 10.7%, p = 0.914), gastrointestinal bleeding (HM III: 17.6% vs. HW: 21.4%, p = 0.761) or systemic infections (HM III: 23.5% vs. HW: 21.4%, p = 0.871). Long-term survival showed no differences between compared groups (mean survival HM III: 426 days vs. HW: 555 days). The main causes of long-term mortality in all patients were adverse CVE in 5 (11.1%), sepsis in 4 (8.9%), suicide in 3 (6.7%), and multiorgan failure in 2 (4.4%).

Conclusion: In the long run, several complications arise following LVAD implantation. Concerning the different LVAD systems, HM III patients show higher risk for drive line infections. This might be due to differences in surface texture of the compared LVAD systems. More high-volume data are required to verify this observation.