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

被引:66
作者
Shehab, Sajad [1 ,2 ]
Macdonald, Peter S. [2 ,3 ,4 ]
Keogh, Anne M. [2 ,3 ,4 ]
Kotlyar, Eugene [2 ,4 ]
Jabbour, Andrew [2 ,3 ,4 ]
Robson, Desiree [2 ]
Newton, Phillip J. [1 ,2 ]
Rao, Sriram [2 ]
Wang, Louis [2 ,3 ,4 ]
Allida, Sabine [1 ]
Connellan, Mark [2 ]
Granger, Emily [2 ]
Dhital, Kumud [2 ]
Spratt, Phillip [2 ]
Jansz, Paul C. [2 ]
Hayward, Christopher S. [1 ,2 ,3 ,4 ]
机构
[1] Univ Technol Sydney, Fac Hlth, Ctr Cardiovasc & Chron Care, Ultimo, NSW, Australia
[2] St Vincents Hosp, Heart Transplant Unit, Darlinghurst, NSW 2010, Australia
[3] Victor Chang Cardiac Res Inst, Darlinghurst, NSW, Australia
[4] Univ New S Wales, Fac Med, POB 1, Kensington, NSW 2033, Australia
关键词
chronic mechanical circulatory support; biventricular ventricular assist device; severe heart failure; outcomess; thrombosis; MECHANICAL CIRCULATORY SUPPORT; INTERMACS ANNUAL-REPORT; FLOW PUMP; EXPERIENCE; DYSFUNCTION; RECIPIENTS; THERAPY;
D O I
10.1016/j.healun.2015.12.001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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; infra-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. (C) Crown Copyright 2016 Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. All rights reserved.
引用
收藏
页码:466 / 473
页数:8
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