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Five-Year Outcome After Continuous Flow LVAD With Full-Magnetic (HeartMate 3) Versus Hybrid Levitation System (HeartWare): A Propensity-Score Matched Study From an All-Comers Multicentre Registry

Despite the withdrawal of the HeartWare Ventricular Assist Device (HVAD), hundreds of patients are still supported with this continuous-flow pump, and the long-term management of these patients is still under debate. This study aims to analyse 5 years survival and freedom from major adverse events i...

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Detalles Bibliográficos
Autores principales: Francica, Alessandra, Loforte, Antonio, Attisani, Matteo, Maiani, Massimo, Iacovoni, Attilio, Nisi, Teodora, Comisso, Marina, Terzi, Amedeo, De Bonis, Michele, Vendramin, Igor, Boffini, Massimo, Musumeci, Francesco, Luciani, Giovanni Battista, Rinaldi, Mauro, Pacini, Davide, Onorati, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505657/
https://www.ncbi.nlm.nih.gov/pubmed/37727385
http://dx.doi.org/10.3389/ti.2023.11675
Descripción
Sumario:Despite the withdrawal of the HeartWare Ventricular Assist Device (HVAD), hundreds of patients are still supported with this continuous-flow pump, and the long-term management of these patients is still under debate. This study aims to analyse 5 years survival and freedom from major adverse events in patients supported by HVAD and HeartMate3 (HM3). From 2010 to 2022, the MIRAMACS Italian Registry enrolled all-comer patients receiving a LVAD support at seven Cardiac Surgery Centres. Out of 447 LVAD implantation, 214 (47.9%) received HM3 and 233 (52.1%) received HVAD. Cox-regression analysis adjusted for major confounders showed an increased risk for mortality (HR 1.5 [1.2–1.9]; p = 0.031), for both ischemic stroke (HR 2.08 [1.06–4.08]; p = 0.033) and haemorrhagic stroke (HR 2.6 [1.3–4.9]; p = 0.005), and for pump thrombosis (HR 25.7 [3.5–188.9]; p < 0.001) in HVAD patients. The propensity-score matching analysis (130 pairs of HVAD vs. HM3) confirmed a significantly lower 5 years survival (41.7% vs. 64.1%; p 0.02), freedom from haemorrhagic stroke (90.5% vs. 70.1%; p < 0.001) and from pump thrombosis (98.5% vs. 74.7%; p < 0.001) in HVAD cohort. Although similar perioperative outcome, patients implanted with HVAD developed a higher risk for mortality, haemorrhagic stroke and thrombosis during 5 years of follow-up compared to HM3 patients.