Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 154 No. 7 (2024)

Clinical outcomes of HeartMate 3 left ventricular assist device support with a Bridge to Transplant vs a Destination Therapy strategy: a single-centre retrospective cohort

DOI
https://doi.org/10.57187/s.3529
Cite this as:
Swiss Med Wkly. 2024;154:3529
Published
10.07.2024

Summary

INTRODUCTION: Real-world outcomes with the HeartMate 3 left ventricular assist device (LVAD) depending on whether it’s a bridge to transplantation (BTT) or destination therapy (DT) are poorly studied. We aimed to compare the profile and clinical outcomes of patients supported with HeartMate 3 according to a BTT or a DT pre-implantation strategy.

METHODS: All patients consecutively implanted with HeartMate 3 at our centre (University Hospital of Lausanne, Switzerland) in 2015–2022 were analysed in a retrospective observational study. Indications for HeartMate 3 implantation were advanced heart failure despite optimal medical treatment. Patients were treated with a vitamin K antagonist anticoagulant combined with antiplatelet therapy after HeartMate 3 implantation and were followed up monthly at our institution.

RESULTS: Among 71 patients implanted with HeartMate 3 between 2015 and 2022, 51 (71.8%) were implanted as a BTT and 20 (28.2%) as DT. Their median age was 58 (IQR: 52–69) years and 84% of patients were classified as INTERMACS profiles 2–4. The median follow-up duration was 18.3 (IQR: 7.5–33.9) months. Patients in the DT group were older than those in the BTT group (p <0.001) and had more chronic renal failure (p <0.001). They also had a lower 5-year survival rate (mean ± standard error: 87.3 ± 5.6% vs 49.4 ± 15.1%) and more adverse events such as renal dysfunction requiring temporary perioperative dialysis (p = 0.08) or bleeding (p = 0.06).

CONCLUSION: Although patients supported with HeartMate 3 have favourable survival, those with LVAD-DT have poorer outcomes. There is a need to better select patients eligible for LVAD-DT in order to limit the burden of adverse events and improve their prognosis.

References

  1. Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007 Sep;93(9):1137–46. doi:10.1136/hrt.2003.025270 DOI: https://doi.org/10.1136/hrt.2003.025270
  2. Roger VL. Epidemiology of heart failure. Circ Res. 2013 Aug;113(6):646–59. doi:10.1161/CIRCRESAHA.113.300268 DOI: https://doi.org/10.1161/CIRCRESAHA.113.300268
  3. Smeets M, Vaes B, Mamouris P, Van Den Akker M, Van Pottelbergh G, Goderis G, et al. Burden of heart failure in Flemish general practices: a registry-based study in the Intego database. BMJ Open. 2019 Jan;9(1):e022972. doi:10.1136/bmjopen-2018-022972 DOI: https://doi.org/10.1136/bmjopen-2018-022972
  4. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep;42(36):3599–726. doi:10.1093/eurheartj/ehab368 DOI: https://doi.org/10.1093/eurheartj/ehab368
  5. Pinney SP, Anyanwu AC, Lala A, Teuteberg JJ, Uriel N, Mehra MR. Left Ventricular Assist Devices for Lifelong Support. J Am Coll Cardiol. 2017 Jun;69(23):2845–61. doi:10.1016/j.jacc.2017.04.031 DOI: https://doi.org/10.1016/j.jacc.2017.04.031
  6. Mehra MR, Goldstein DJ, Cleveland JC, Cowger JA, Hall S, Salerno CT, et al. Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial. JAMA. 2022 Sep;328(12):1233–42. doi:10.1001/jama.2022.16197 DOI: https://doi.org/10.1001/jama.2022.16197
  7. Hullin R, Meyer P, Yerly P, Kirsch M. Cardiac Surgery in Advanced Heart Failure. J Clin Med. 2022 Jan;11(3):773. doi:10.3390/jcm11030773 DOI: https://doi.org/10.3390/jcm11030773
  8. Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, et al.; International Society for Heart Lung Transplantation (ISHLT) Infectious Diseases, Pediatric and Heart Failure and Transplantation Councils. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. J Heart Lung Transplant. 2016 Jan;35(1):1–23. doi:10.1016/j.healun.2015.10.023 DOI: https://doi.org/10.1016/j.healun.2015.10.023
  9. Nowacka A, Hullin R, Tozzi P, Barras N, Regamey J, Yerly P, et al. Short-term single-centre experience with the HeartMate 3 left ventricular assist device for advanced heart failure. Eur J Cardiothorac Surg. 2020 Sep;58(3):511–8. doi:10.1093/ejcts/ezaa075 DOI: https://doi.org/10.1093/ejcts/ezaa075
  10. Schmitto JD, Molitoris U, Haverich A, Strueber M. Implantation of a centrifugal pump as a left ventricular assist device through a novel, minimized approach: upper hemisternotomy combined with anterolateral thoracotomy. J Thorac Cardiovasc Surg. 2012 Feb;143(2):511–3. doi:10.1016/j.jtcvs.2011.07.046 DOI: https://doi.org/10.1016/j.jtcvs.2011.07.046
  11. Pfister R, Tozzi P, Hullin R, Yerly P, Jahns FP, Prêtre R et al. HeartMate 3 implantation via left antero-lateral thoracotomy to avoid resternotomy in high risk patients. Multimed Man Cardiothorac Surg. 2018 Apr;2018 doi:10.1510/mmcts.2018.026 DOI: https://doi.org/10.1510/mmcts.2018.026
  12. Hanke JS, Krabatsch T, Rojas SV, Deniz E, Ismail I, Martens A, et al. In Vitro Evaluation of Inflow Cannula Fixation Techniques in Left Ventricular Assist Device Surgery. Artif Organs. 2017 Mar;41(3):272–5. doi:10.1111/aor.12735 DOI: https://doi.org/10.1111/aor.12735
  13. Schibilsky D, Benk C, Haller C, Berchtold-Herz M, Siepe M, Beyersdorf F, et al. Double tunnel technique for the LVAD driveline: improved management regarding driveline infections. J Artif Organs. 2012 Mar;15(1):44–8. doi:10.1007/s10047-011-0607-3 DOI: https://doi.org/10.1007/s10047-011-0607-3
  14. Lenoir M, Quessard A, N’guyen A, Kirsch M. Simplified temporary right ventricular support after implantation of a left ventricular assist device. Heart Surg Forum. 2013 Jun;16(3):E152–4. doi:10.1532/HSF98.20131003 DOI: https://doi.org/10.1532/HSF98.20131003
  15. Stevenson LW, Pagani FD, Young JB, Jessup M, Miller L, Kormos RL, et al. INTERMACS profiles of advanced heart failure: the current picture. J Heart Lung Transplant. 2009 Jun;28(6):535–41. doi:10.1016/j.healun.2009.02.015 DOI: https://doi.org/10.1016/j.healun.2009.02.015
  16. Kormos RL, Antonides CF, Goldstein DJ, Cowger JA, Starling RC, Kirklin JK, et al. Updated definitions of adverse events for trials and registries of mechanical circulatory support: A consensus statement of the mechanical circulatory support academic research consortium. J Heart Lung Transplant. 2020 Aug;39(8):735–50. doi:10.1016/j.healun.2020.03.010 DOI: https://doi.org/10.1016/j.healun.2020.03.010
  17. Hannan MM, Husain S, Mattner F, Danziger-Isakov L, Drew RJ, Corey GR, et al.; International Society for Heart and Lung Transplantation. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transplant. 2011 Apr;30(4):375–84. doi:10.1016/j.healun.2011.01.717 DOI: https://doi.org/10.1016/j.healun.2011.01.717
  18. Zimpfer D, Gustafsson F, Potapov E, Pya Y, Schmitto J, Berchtold-Herz M, et al. Two-year outcome after implantation of a full magnetically levitated left ventricular assist device: results from the ELEVATE Registry. Eur Heart J. 2020 Oct;41(39):3801–9. doi:10.1093/eurheartj/ehaa639 DOI: https://doi.org/10.1093/eurheartj/ehaa639
  19. Schmitto JD, Pya Y, Zimpfer D, Krabatsch T, Garbade J, Rao V, et al. Long-term evaluation of a fully magnetically levitated circulatory support device for advanced heart failure-two-year results from the HeartMate 3 CE Mark Study. Eur J Heart Fail. 2019 Jan;21(1):90–7. doi:10.1002/ejhf.1284 DOI: https://doi.org/10.1002/ejhf.1284
  20. Mehra MR, Uriel N, Naka Y, Cleveland JC Jr, Yuzefpolskaya M, Salerno CT, et al.; MOMENTUM 3 Investigators. A Fully Magnetically Levitated Left Ventricular Assist Device - Final Report. N Engl J Med. 2019 Apr;380(17):1618–27. doi:10.1056/NEJMoa1900486 DOI: https://doi.org/10.1056/NEJMoa1900486
  21. Saeed D, Feldman D, Banayosy AE, Birks E, Blume E, Cowger J, et al. The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: A 10- Year Update. J Heart Lung Transplant. 2023 Jul;42(7):e1–222. doi:10.1016/j.healun.2022.12.004 DOI: https://doi.org/10.1016/j.healun.2022.12.004
  22. Mehra MR, Netuka I, Uriel N, Katz JN, Pagani FD, Jorde UP, et al.; ARIES-HM3 Investigators. Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial. JAMA. 2023 Dec;330(22):2171–81. doi:10.1001/jama.2023.23204 DOI: https://doi.org/10.1001/jama.2023.23204
  23. Meredith T, Schnegg B, Hayward C. The use of direct oral anticoagulants in patients with ventricular assist devices: is there hope for Factor Xa inhibition? Artif Organs. 2021 May;45(5):E123–9. doi:10.1111/aor.13848 DOI: https://doi.org/10.1111/aor.13848
  24. Whitehouse KR, Avula D, Kahlon T, Costelle D, Dunbar-Matos C, Pahwa S, et al. Apixaban: Alternative Anticoagulation for HeartMate 3 Ventricular Assist Device. ASAIO J. 2022 Mar;68(3):318–22. doi:10.1097/MAT.0000000000001650 DOI: https://doi.org/10.1097/MAT.0000000000001650
  25. Dimond M, Looby M, Shah B, Sinha SS, Isseh I, Rollins AT, et al. Design and Rationale for the Direct Oral Anticoagulant Apixaban in Left Ventricular Assist Devices (DOAC LVAD) Study. J Card Fail. 2023 Nov;S1071-9164(23)00863-1 DOI: https://doi.org/10.1016/j.cardfail.2023.10.473
  26. Hullin R, Abdurashidova T, Pitta-Gros B, Schukraft S, Rancati V, Lu H, et al. Post-transplant survival with pre-transplant durable continuous-flow mechanical circulatory support in a Swiss cohort of heart transplant recipients. Swiss Med Wkly. 2023 Dec;153(12):3500. doi:10.57187/s.3500 DOI: https://doi.org/10.57187/s.3500
  27. Goldstein DJ, Naka Y, Horstmanshof D, Ravichandran AK, Schroder J, Ransom J, et al. Association of Clinical Outcomes With Left Ventricular Assist Device Use by Bridge to Transplant or Destination Therapy Intent: The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) Randomized Clinical Trial. JAMA Cardiol. 2020 Apr;5(4):411–9. doi:10.1001/jamacardio.2019.5323 DOI: https://doi.org/10.1001/jamacardio.2019.5323
  28. Tse G, Gong M, Wong SH, Wu WK, Bazoukis G, Lampropoulos K, et al.; International Health Informatics Study (IHIS) Network. Frailty and Clinical Outcomes in Advanced Heart Failure Patients Undergoing Left Ventricular Assist Device Implantation: A Systematic Review and Meta-analysis. J Am Med Dir Assoc. 2018 Mar;19(3):255–261.e1. doi:10.1016/j.jamda.2017.09.022 DOI: https://doi.org/10.1016/j.jamda.2017.09.022
  29. Cain MT, Firstenberg MS, Cleveland JC Jr. Heart Transplant and Ventricular Assist: Cardiac Surgery and Heart Failure Perspective. US Cardiol. 2021 Sep;15:e16. doi:10.15420/usc.2021.11 DOI: https://doi.org/10.15420/usc.2021.11

Most read articles by the same author(s)

1 2 > >>