Thorac Cardiovasc Surg 2019; 67(S 01): S1-S100
DOI: 10.1055/s-0039-1678825
Oral Presentations
Sunday, February 17, 2019
DGTHG: Therapie mit Herzunterstützungssystemen
Georg Thieme Verlag KG Stuttgart · New York

The HeartWare HVAD System for the Treatment of Advanced Heart Failure Patients with Biventricular Support

D. Zimpfer
1   Department of Cardiac Surgery, Medical University of Vienna, Wien, Austria
,
J. Riebandt
1   Department of Cardiac Surgery, Medical University of Vienna, Wien, Austria
,
C. Hayward
2   Heart Lung Transplant Unit, St. Vincent’s Hospital, Sydney, Australia
,
R. Schramm
3   Department of Cardiac Surgery, University of Munich, Munich, Germany
,
M. Ozbaran
4   Department of Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey
,
C. Engin
4   Department of Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey
,
J. Garbade
5   Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
,
A. Simon
6   Department of Cardiothoracic Transplantation and Mechanical Support, Harefield Hospital, Royal Brompton and Harefield Hospital, Harefield, United Kingdom
,
S. Tsui
7   Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
,
F. Wagner
8   Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
,
E. A. Fiane
9   Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
,
M. Paç
10   Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
,
U. Kervan
10   Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
,
D. J. Schmitto
11   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Publikationsdatum:
28. Januar 2019 (online)

 
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    Background: Approximately 10 to 20% of patients with advanced heart failure cannot be treated with a left ventricular assist device (LVAD) alone. Patients presenting with biventricular heart failure are generally sicker than those with left ventricular heart failure, and they have few options outside of cardiac transplantation. The small size of the HVAD Ventricular Assist System has led many surgeons to implant two HVAD pumps in a biventricular assist device (BiVAD) configuration. However, the HVAD was designed to be used as a LVAD system. Various adaptations have been described when the HVAD has been implanted for right ventricular support. We present here a retrospective analysis of aggregate data from BiVAD implants at various centers in Europe and Australia.

    Methods: This retrospective study identified 93 patients (mean age 47.4 ± 12.93 years, 75.3% male, 34.5% INTERMACS Profile 1, 34.1% ECMO) implanted with HVADs as a BiVAD at 12 international centers between 2009 and 2017. Comparison of the right atrial (n = 32) versus right ventricular (n = 56) implants was made, as well as Kaplan–Meier estimated survival through 2 years with various implant approaches. Secondary end points included adverse event profiles and survival to heart transplantation.

    Results: No significant differences in the adverse events rates were seen between the two groups, except for cardiac arrhythmias which occurred only in the right atrial group (12.5%). Regardless of timing and site of the RVAD implantation, at 1 year, 12.7% of the patients had been transplanted and 44% were still on device. The event-free rate at 2 years was 48% in both groups.

    Conclusion: This analysis represents the largest retrospective review of the use of the HVAD System in biventricular support. Overall survival is similar to that reported by Intermacs for survival on continuous flow BiVADs.

    Survival through 2 years is similar regardless of timing of right-sided VAD or implant location. Nonetheless, the retrospective design limits broad data generalizations.


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