Long-term biventricular HeartWare ventricular assist device support - Case series of right atrial and right ventricular implantation outcomes

Shehab, S; Macdonald, PS; Keogh, AM; Kotlyar, E; Jabbour, A; Robson, D; Newton, PJ; Rao, S; Wang, L; Allida, S; Connellan, M; Granger, E; Dhital, K; Spratt, P; Jansz, PC; Hayward, CS

Long-term biventricular HeartWare ventricular assist device support - Case series of right atrial and right ventricular implantation outcomes

Shehab, S Macdonald, PS

Keogh, AM Kotlyar, E Jabbour, A Robson, D Newton, PJ

Rao, S Wang, L Allida, S

Connellan, M Granger, E Dhital, K Spratt, P Jansz, PC Hayward, CS

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Publication Type:: Journal Article
Citation:: Journal of Heart and Lung Transplantation, 2016, 35 (4), pp. 466 - 473
Issue Date:: 2016-04-01

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Field	Value	Language
dc.contributor.author	Shehab, S	en_US
dc.contributor.author	Macdonald, PS https://orcid.org/0000-0001-5378-2825	en_US
dc.contributor.author	Keogh, AM	en_US
dc.contributor.author	Kotlyar, E	en_US
dc.contributor.author	Jabbour, A	en_US
dc.contributor.author	Robson, D	en_US
dc.contributor.author	Newton, PJ https://orcid.org/0000-0002-5006-2037	en_US
dc.contributor.author	Rao, S	en_US
dc.contributor.author	Wang, L	en_US
dc.contributor.author	Allida, S https://orcid.org/0000-0003-0161-8649	en_US
dc.contributor.author	Connellan, M	en_US
dc.contributor.author	Granger, E	en_US
dc.contributor.author	Dhital, K	en_US
dc.contributor.author	Spratt, P	en_US
dc.contributor.author	Jansz, PC	en_US
dc.contributor.author	Hayward, CS	en_US
dc.date.available	2015-12-04	en_US
dc.date.issued	2016-04-01	en_US
dc.identifier.citation	Journal of Heart and Lung Transplantation, 2016, 35 (4), pp. 466 - 473	en_US
dc.identifier.issn	1053-2498	en_US
dc.identifier.uri	http://hdl.handle.net/10453/90499
dc.description.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/m2. 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.	en_US
dc.relation.ispartof	Journal of Heart and Lung Transplantation	en_US
dc.relation.isbasedon	10.1016/j.healun.2015.12.001	en_US
dc.subject.classification	Surgery	en_US
dc.subject.mesh	Heart Ventricles	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Cardiomyopathy, Dilated	en_US
dc.subject.mesh	Treatment Outcome	en_US
dc.subject.mesh	Heart-Assist Devices	en_US
dc.subject.mesh	Heart Transplantation	en_US
dc.subject.mesh	Registries	en_US
dc.subject.mesh	Survival Rate	en_US
dc.subject.mesh	Retrospective Studies	en_US
dc.subject.mesh	Follow-Up Studies	en_US
dc.subject.mesh	Time Factors	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.title	Long-term biventricular HeartWare ventricular assist device support - Case series of right atrial and right ventricular implantation outcomes	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	35	en_US
utslib.for	1102 Cardiorespiratory Medicine and Haematology	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	35	en_US

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/m2. 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.

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http://hdl.handle.net/10453/90499