Clinical Outcome and Comparison of Three Different Left Ventricular Assist Devices in a High-Risk Cohort

K. Zhigalov; A. Mashhour; M. Szczechowicz; S. Mkalaluh; I. Gogia; S. Karagezian; J. Easo; J. Ennker; H. Eichstaedt; A. Weymann

doi:10.1055/s-0038-1628108

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2018; 66(S 01): S1-S110
DOI: 10.1055/s-0038-1628108

Short Presentations

Sunday, February 18, 2018

DGTHG: Heart-Lung-Failure

Georg Thieme Verlag KG Stuttgart · New York

Clinical Outcome and Comparison of Three Different Left Ventricular Assist Devices in a High-Risk Cohort

Authors

K. Zhigalov

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
A. Mashhour

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
M. Szczechowicz

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
S. Mkalaluh

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
I. Gogia

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
S. Karagezian

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
J. Easo

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
J. Ennker

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
H. Eichstaedt

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
A. Weymann

¹Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany

Abstract

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Objectives: We present a comparison between three left ventricular assist devices (LVAD): HeartWare (HVAD) (HeartWare International Inc., Framingham, Massachusetts, United States), HeartMate II (HMII) and HeartMate III (HMIII) (Thoratec Corp., Pleasanton, California, United States). To our knowledge, no study to date has aimed at placing these three devices in juxtaposition.

Methods: Between June 2007 and June 2017, 108 consecutive patients received HMII, n = 77 (71.3%), HVAD, n = 14 (13%), or HM III, n = 17 (15.7%), for end-stage heart failure. Mean age was 63.8 ± 11.2 years (range 24–84 years), with median INTERMACS profile of three. Preoperatively, 26 patients (24.1%) were ventilated, 17 patients (15.7%) had an intraaortic balloon pump, 27 patients (25%) were on extracorporeal life support.

Results: Overall survival at 30 days was 70.4%, at 1 year 51.9% and at 5 years 38% with no significant difference in survival between HMII, HVAD and HMIII. Median cardiopulmonary bypass time was 113 minutes (range 50–371 minutes). Two patients received a minimally-invasive procedure. Most common adverse events were revision for bleeding (42.6%), tracheotomy (33.3%), acute kidney failure with new-onset dialysis (25%), sepsis (17.6%) and gastrointestinal bleeding (10.2%). The average duration of follow-up was 1.52 ± 2.11 years (range 0–7.95 years). The median number of readmissions was 2 (range 0–23), the median length of hospital stay as readmission was 17 days (range 0–158 days). Strong predictors of overall mortality (p < 0.05) were postoperative sepsis (OR = 5.729, 95%CI = 3.001–10.937), intra-/postoperative need for mechanical support (OR = 5.232, 95%CI = 3.008–9.102), preoperative extracorporeal life support (OR = 2.980, 95%CI = 1.615–5.500), readmission because of suboptimal INR value (OR = 2.748, 95%CI = 1.045–7.226), need of inotropes over 7 days postoperatively (OR = 2.556, 95%CI = 1.432–4.562), new onset of temporary hemodialysis postoperatively (OR = 1.986, 95%CI = 1.084–3.635) and female gender (OR = 1.955, 95%CI = 1.062–3.598).

Conclusion: No significant difference in mortality between HMII, HVAD, and HMIII was observed. The following predictors of overall mortality were identified (p < 0.05): postoperative sepsis, need for perioperative mechanical support, readmission because of suboptimal INR value, new onset of temporary hemodialysis postoperatively and female gender.