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Published on: February 13, 2021
HeartWare-HVAD for end-stage heart failure: a review of clinical experiences with ≥50 patients
Luca Botta1, Benedetta De Chiara2, Francesca Macera2
1a Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department , Niguarda Hospital , Milano , Italy.
Insights
The HeartWare-HVAD is a small device offering circulatory support for end-stage heart failure (ESHF), primarily as a bridge to heart transplantation (HTx). While early outcomes are good, ongoing complications necessitate further development for improved long-term results.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- End-stage heart failure (ESHF) incidence is rising despite medical and surgical advances.
- Continuous-flow ventricular assist devices (VADs) are crucial for supporting failing left ventricles.
- The HeartWare-HVAD, a centrifugal pump VAD, represents a significant development in mechanical circulatory support.
Purpose of the Study:
- To provide a comprehensive overview of the HeartWare-HVAD for ESHF.
- To discuss its indications, echocardiographic assessment, and surgical implantation techniques.
- To analyze outcomes, complications, and controversies associated with the HeartWare-HVAD.
Main Methods:
- A systematic literature review was conducted using MEDLINE.
- Search terms included 'HeartWare' or 'HVAD' combined with 'heart failure'.
- 16 high-evidence papers reporting outcomes in ≥50 patients were selected from 263 initial results.
Main Results:
- The HeartWare-HVAD is a compact device providing full circulatory support for ESHF patients.
- Its primary indication is as a bridge to heart transplantation (HTx).
- Median sternotomy is the common implantation technique, though less invasive methods exist; early outcomes are satisfactory, but mid- to long-term complications persist.
Conclusions:
- The HeartWare-HVAD offers effective circulatory support for ESHF.
- Continued technical innovation and optimized medical management are essential for improving long-term patient outcomes.
- Addressing mid- and long-term complications is key to maximizing the benefits of this VAD.
Introduction:
Despite the improvements in medical and surgical treatments, the incidence of end-stage heart failure (ESHF) continues to increase. Different mechanical systems have been adopted to support failing left ventricles. Among continuous-flow devices, the HeartWare-HVAD was the first to use a centrifugal pump rather than an axial one. Areas covered: In this review article, we provide an overview of the HeartWare-HVAD as a ventricular assist device for ESHF, discussing indications, echocardiographic assessment, surgical techniques, outcomes, concerns and controversies. Scientific literature was reviewed with a MEDLINE search strategy combining 'HeartWare' or 'HVAD' with 'heart failure'. A total of 263 papers were found using the reported search. From these, 16 were identified to provide the best evidence on the subject reporting outcomes in ≥50 patients. Expert commentary: HeartWare-HVAD is a minute device that provides full circulatory support in patients with ESHF. Its main indication remains bridge to heart transplantation (HTx). Median sternotomy is the preferred technique of implantation although less invasive procedures have been described. Early outcomes are satisfactory. Nevertheless, some fearing complications still occur during the mid- and long-term follow-up. Further technical developments and optimal medical management will guarantee better outcomes.
