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Widening care gap in VAD therapy.

Jennifer Conway1, Shahnawaz Amdani2, David L S Morales3

  • 1Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.

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Summary

The HeartWare ventricular assist device (HVAD) removal created a gap for younger patients. The HeartMate 3 (HM3) offers good survival, but pediatric patients may still face access limitations for intracorporeal support.

Keywords:
heart failuremechanical circulatory supportpediatricstransplantationventricular assist deviceyoung adults

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Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Medical Devices

Background:

  • The discontinuation of the HeartWare ventricular assist device (HVAD) has created a care gap for pediatric and young adult patients.
  • It remains unclear how HVAD survival rates differ by age and if the HeartMate 3 (HM3) can adequately address this gap.

Purpose of the Study:

  • To compare the survival outcomes of young adults (YA) and pediatric patients implanted with durable ventricular assist devices (VADs).
  • To evaluate the performance of the HeartMate 3 (HM3) device in bridging the care gap left by the HVAD.

Main Methods:

  • Utilized the STS Intermacs and Pedimacs registries for VAD implants between September 2012 and December 2021.
  • Defined young adults as <40 years old and excluded patients with isolated RVAD or destination therapy implants.
  • Performed survival analysis using Kaplan-Meier curves and competing outcomes, reporting 1-year survival rates.

Main Results:

  • Young adults (YA) showed better HVAD survival than older adults (>40 years) (88.8% vs. 79.4%).
  • YA survival was superior to pediatric patients (88.9% vs. 83.7%), but mortality was similar when accounting for competing events.
  • HeartMate 3 (HM3) demonstrated improved survival in YA compared to HVAD (94.4% vs. 88.8%), a difference not observed in all pediatric patients.

Conclusions:

  • The HeartMate 3 (HM3) device can partially fill the care gap for young patients following HVAD removal.
  • A subset of pediatric patients may still face limitations in accessing intracorporeal support, impacting discharge potential.
  • Future device availability decisions must consider diverse patient populations to prevent access inequality.