Continuous-flow LVAD exchange to a different pump model: Systematic review and meta-analysis of the outcomes.

Authors

• Melissa A Austin
• Elizabeth J Maynes
• Marc N Gadda
• Thomas J O'Malley
• Rohinton J Morris
• Mahek K Shah
• Preethi R Pirlamarla
• Rene J Alvarez
• John W Entwistle
• Howard Todd Massey
• Vakhtang Tchantchaleishvili

Publication/Presentation Date

7-1-2021

Abstract

Despite improved outcomes of modern continuous-flow left ventricular assist devices (CF-LVADs), device exchange is still needed for various indications. While the majority of CF-LVADs are exchanged to the same model, exchange to a different pump model is occasionally warranted. In this meta-analysis, we sought to consolidate the existing evidence to better elucidate the indications and outcomes in these cases. A comprehensive systematic search of adult patient cohorts who underwent CF-LVAD exchange to a different CF-LVAD model was performed. Study-level data from 10 studies comprising 98 patients were extracted and pooled for analysis. Mean patient age was 58 (95% CI: 48-65) and 81% were male. Indication for initial CF-LVAD was ischemic cardiomyopathy in 45% (34-57). Initial device was HeartMate II LVAD (HMII) in 93 (94.9%) and HeartWare HVAD (HW) in 5 (5.1%) patients. After mean CF-LVAD support time of 18.8 (15.2-22.4) months, exchange indications included thrombosis in 71% (43-89), infection in 21% (8-47) and device malfunction in 12% (7-21). HMII to HW exchange occurred in 53 (54.1%) patients, HMII to HeartMate III (HM3) in 32 (32.7%), and HM II to either HW or HM3 in 13 (13.2%) patients. Postoperatively, right ventricular assist device was required in 16% (8-32). Overall, 20% (8-40) of patients experienced a stroke, while HW patients had a significantly higher stroke incidence than HM3 patients (HW: 21% (8-47) vs. HM3: 5% (1-24), P < .01). Overall 30-day mortality was 10% (6-17), while HW had a significantly worse 30-day mortality than HM3 (HW: 13% (7-24) vs. HM3: 5% (1-24), P = .03). Following device exchange from a different CF-LVAD model, HM3 is associated with lower stroke and higher survival when compared to HW.

Volume

45

Issue

7

First Page

696

Last Page

705

ISSN

1525-1594

Published In/Presented At

Austin, M. A., Maynes, E. J., Gadda, M. N., O'Malley, T. J., Morris, R. J., Shah, M. K., Pirlamarla, P. R., Alvarez, R. J., Entwistle, J. W., Massey, H. T., & Tchantchaleishvili, V. (2021). Continuous-flow LVAD exchange to a different pump model: Systematic review and meta-analysis of the outcomes. Artificial organs, 45(7), 696–705. https://doi.org/10.1111/aor.13893

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

33350485

Department(s)

Administration and Leadership

Document Type

Article