Sajad Shehab1, Peter S Macdonald2, Anne M Keogh2, Eugene Kotlyar3, Andrew Jabbour2, Desiree Robson4, Phillip J Newton1, Sriram Rao4, Louis Wang2, Sabine Allida5, Mark Connellan4, Emily Granger4, Kumud Dhital4, Phillip Spratt4, Paul C Jansz4, Christopher S Hayward6. 1. Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo; Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst. 2. Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst; Victor Chang Cardiac Research Institute, Darlinghurst; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia. 3. Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia. 4. Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst. 5. Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo. 6. Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Ultimo; Heart Transplant Unit, St. Vincent's Hospital, Darlinghurst; Victor Chang Cardiac Research Institute, Darlinghurst; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia. Electronic address: cshayward@stvincents.com.au.
Abstract
BACKGROUND: There is limited information on outcomes using the HeartWare ventricular assist device (HVAD; HeartWare, Framington, MA) as a biventricular assist device, especially with respect to site of right ventricular assist device (RVAD) implantation. METHODS: Outcomes in 13 patients with dilated cardiomyopathy and severe biventricular failure who underwent dual HVAD implantation as bridge to transplantation between August 2011 and October 2014 were reviewed. RESULTS: Of 13 patients, 10 were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1, and 3 were INTERMACS Level 2. Mean age was 45 ± 11 years, and mean body mass index was 26 ± 4 kg/m(2). There were 7 patients on temporary mechanical support pre-operatively (extracorporeal life support, n = 5; intra-aortic balloon pump, n = 2). The median hospital length of stay was 53 days (interquartile range [IQR] 33-70 days) with a median intensive care unit length of stay of 14 days (IQR 8-36 days). The median length of support on device was 269 days (IQR 93-426 days). The right HVAD was implanted in the right ventricular (RV) free wall in 6 patients and in the right atrial (RA) free wall in 7 patients. Transplantation was successfully performed in 5 patients, and overall survival for the entire cohort was 54%. RVAD pump thrombosis occurred in 3 of 6 RV pumps and 1 of 7 RA pumps. No left ventricular assist device pump thrombosis was observed. Bleeding tended to be higher in the RV implantation group (3 of 6 vs 0 of 7). During follow up, 6 patients died (4 of 7 in the RA group vs 2 of 6 in the RV group). Cause of death was multiple-organ failure in 3 patients, sepsis in 2 patients, and intracerebral hemorrhage in 1 patient. CONCLUSIONS: Critically ill patients who require biventricular support can be successfully bridged to transplant using 2 HVADs. RA implantation may allow right heart support with lower pump thrombosis and bleeding complications, although this was at the expense of a higher mortality in this cohort. Crown
BACKGROUND: There is limited information on outcomes using the HeartWare ventricular assist device (HVAD; HeartWare, Framington, MA) as a biventricular assist device, especially with respect to site of right ventricular assist device (RVAD) implantation. METHODS: Outcomes in 13 patients with dilated cardiomyopathy and severe biventricular failure who underwent dual HVAD implantation as bridge to transplantation between August 2011 and October 2014 were reviewed. RESULTS: Of 13 patients, 10 were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1, and 3 were INTERMACS Level 2. Mean age was 45 ± 11 years, and mean body mass index was 26 ± 4 kg/m(2). There were 7 patients on temporary mechanical support pre-operatively (extracorporeal life support, n = 5; intra-aortic balloon pump, n = 2). The median hospital length of stay was 53 days (interquartile range [IQR] 33-70 days) with a median intensive care unit length of stay of 14 days (IQR 8-36 days). The median length of support on device was 269 days (IQR 93-426 days). The right HVAD was implanted in the right ventricular (RV) free wall in 6 patients and in the right atrial (RA) free wall in 7 patients. Transplantation was successfully performed in 5 patients, and overall survival for the entire cohort was 54%. RVAD pump thrombosis occurred in 3 of 6 RV pumps and 1 of 7 RA pumps. No left ventricular assist device pump thrombosis was observed. Bleeding tended to be higher in the RV implantation group (3 of 6 vs 0 of 7). During follow up, 6 patients died (4 of 7 in the RA group vs 2 of 6 in the RV group). Cause of death was multiple-organ failure in 3 patients, sepsis in 2 patients, and intracerebral hemorrhage in 1 patient. CONCLUSIONS:Critically illpatients who require biventricular support can be successfully bridged to transplant using 2 HVADs. RA implantation may allow right heart support with lower pump thrombosis and bleeding complications, although this was at the expense of a higher mortality in this cohort. Crown
Authors: Jaime-Jürgen Eulert-Grehn; Pia Lanmüller; Christoph Starck; Felix Hennig; Stephan Jacobs; Volkmar Falk; Evgenij Potapov Journal: Ann Cardiothorac Surg Date: 2021-05
Authors: Bastian Schmack; Alexander Weymann; Frank Ruschitzka; Rüdiger Autschbach; Philip W Raake; Nadine Jurrmann; Ares K Menon; Matthias Karck; Markus J Wilhelm; Arjang Ruhparwar Journal: Clin Res Cardiol Date: 2018-01-02 Impact factor: 5.460
Authors: Elizabeth J Maynes; Thomas J O'Malley; Jessica G Y Luc; Matthew P Weber; Dylan P Horan; Jae Hwan Choi; Sinal Patel; Syed-Saif Abbas Rizvi; Rohinton J Morris; John W Entwistle; H Todd Massey; Vakhtang Tchantchaleishvili Journal: Ann Cardiothorac Surg Date: 2020-03
Authors: Andrew Y Lin; Hao Tran; Michela Brambatti; Eric Adler; Victor Pretorius; Travis Pollema; Jonathan C Hsu; Gregory K Feld; Kurt Hoffmayer; Frederick Han; David Krummen; Gordon Ho Journal: J Interv Card Electrophysiol Date: 2019-12-14 Impact factor: 1.900
Authors: James Farag; Kei Woldendorp; Nicholas McNamara; Paul G Bannon; Silvana F Marasco; Antonio Loforte; Evgenij V Potapov Journal: Ann Cardiothorac Surg Date: 2021-05