Clinical experience with HeartWare left ventricular assist device in patients with end-stage heart failure

Objectives: At present the most definitive therapeutic option for end-stage heart failure is cardiac transplantation. However, this method is in its availability due to a lack of available organs limited. This is why ventricular assist devices (VADs) capable of supporting the circulation are playing an increasingly important role in the management of heart failure therapy. The objective of this study is to review our experience with the new miniaturized centrifugal HVAD pump (HeartWare Inc, Framingham, MA).

Methods: From March 2007 to June 2011, 34 patients underwent a HVAD pump implantation in the Department of Cardiothoracic Transplantation & Mechanical support at Royal Brompton and Harefield NHS Foundation Trust, London. Indication for implantation was end-stage heart failure refractory to medical treatment.

Results: Twenty-nine male and 5 female patients with a mean age of 51 years (20–66) were supported on HVAD pump for a total of 9132 patient-days. Mean duration of support was 261±264 (range 8 to 1369) days. The cause of heart failure was dilated cardiomyopathy in 25 patients, ischemic cardiomyopathy in 8 patients and hypertrophic cardiomyopathy in 1 patient. Four patients had to implant a temporary right heart assist system after LVAD due to right heart failure. Twenty-six patients are currently alive and well out of which 5 patients were bridged to transplantation. Eight patients died in the observation period. Complications included reoperation for bleeding in 5 (15%), infection in 5 (15%), respiratory failure in 7 (21%), and stroke in 3 (9%). The mechanical device failure was occurred in one patient. Postoperative echocardiography at follow-up showed an acceptable offloading of the left ventricle with a significantly improvement of fraction shortening after 1, 3, and 9 months.

Conclusion: The HVAD is capable of providing left ventricular support for patients with end-stage heart failure with an acceptable midterm survival and it can be used successfully as a bridge to transplantation.