Using existing technology better: Improving outcomes with the HeartWare left ventricular assist device.

Area of Science:

• Cardiology
• Medical Devices
• Clinical Outcomes

Background:

• The HeartWare left ventricular assist device (LVAD) has been clinically utilized for over a decade.
• Assessing temporal trends in LVAD outcomes is crucial for refining patient care.

Purpose of the Study:

• To evaluate the evolution of outcomes for patients receiving the HeartWare LVAD at a single center over time.
• To identify factors contributing to improvements in survival and complications.

Main Methods:

• A retrospective review of electronic hospital records was conducted at the Freeman Hospital.
• 255 adult patients receiving their first HeartWare LVAD implant were analyzed, divided into two eras: 2009-2015 (Era 1) and 2016-2020 (Era 2).
• Patient selection criteria, specifically Intermacs Classification, were prospectively modified in Era 2 to include lower-risk patients.

Main Results:

• A significant shift towards lower-risk Intermacs classifications was observed in Era 2 (P < 0.001).
• One-year survival improved significantly from 70% in Era 1 to 80% in Era 2 (P < 0.05), primarily due to reduced 30-day mortality (1.7% vs 15.5%, P < 0.005).
• Improved right ventricular function and increased use of temporary right ventricular assist devices were noted in Era 2, though deaths from intracranial hemorrhage, sepsis, and right heart failure remained unchanged.

Conclusions:

• Enhanced patient selection and increased utilization of temporary right ventricular support have demonstrably improved survival rates for LVAD patients.
• Despite survival gains, intracranial hemorrhage, sepsis, and right heart failure continue to pose significant clinical challenges requiring further attention.