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

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

doi:10.1111/aor.13893

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

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^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

13 Scopus citations

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.

Original language	English
Pages (from-to)	696-705
Number of pages	10
Journal	Artificial Organs
Volume	45
Issue number	7
DOIs	https://doi.org/10.1111/aor.13893
State	Published - Jul 2021
Externally published	Yes

Keywords

exchange
heart failure
left ventricular assist device

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10.1111/aor.13893

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@article{24b587b140104c51ab1dc94d9c6c5631,

title = "Continuous-flow LVAD exchange to a different pump model: Systematic review and meta-analysis of the outcomes",

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.",

keywords = "exchange, heart failure, left ventricular assist device",

author = "Austin, {Melissa A.} and Maynes, {Elizabeth J.} and Gadda, {Marc N.} and O'Malley, {Thomas J.} and Morris, {Rohinton J.} and Shah, {Mahek K.} and Pirlamarla, {Preethi R.} and Alvarez, {Rene J.} and Entwistle, {John W.} and Massey, {Howard Todd} and Vakhtang Tchantchaleishvili",

note = "Publisher Copyright: {\textcopyright} 2021 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.",

year = "2021",

month = jul,

doi = "10.1111/aor.13893",

language = "English",

volume = "45",

pages = "696--705",

journal = "Artificial Organs",

issn = "0160-564X",

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TY - JOUR

T1 - Continuous-flow LVAD exchange to a different pump model

T2 - Systematic review and meta-analysis of the outcomes

AU - Austin, Melissa A.

AU - Maynes, Elizabeth J.

AU - Gadda, Marc N.

AU - O'Malley, Thomas J.

AU - Morris, Rohinton J.

AU - Shah, Mahek K.

AU - Pirlamarla, Preethi R.

AU - Alvarez, Rene J.

AU - Entwistle, John W.

AU - Massey, Howard Todd

AU - Tchantchaleishvili, Vakhtang

PY - 2021/7

Y1 - 2021/7

N2 - 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.

AB - 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.

KW - exchange

KW - heart failure

KW - left ventricular assist device

UR - http://www.scopus.com/inward/record.url?scp=85100866244&partnerID=8YFLogxK

U2 - 10.1111/aor.13893

DO - 10.1111/aor.13893

M3 - Review article

C2 - 33350485

AN - SCOPUS:85100866244

SN - 0160-564X

VL - 45

SP - 696

EP - 705

JO - Artificial Organs

JF - Artificial Organs

IS - 7

ER -

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

Abstract

Keywords

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