Device exchange from Heartmate II to HeartWare HVAD.

BACKGROUND: Despite technological advancements, pump durability and pump-related complications continue to affect and adversely impact the lives of patients with end-stage heart failure on left ventricular assist device (LVAD) support. In an attempt to avoid recurrent LVAD-related complications, there may be circumstances where it is clinically advantageous to exchange a patient's device from HeartMate II to HeartWare HVAD. However, there is a paucity of data that describes the safety and feasibility of such an approach. OBJECTIVE: We present the largest single-center series of HeartMate II (HMII) to HeartWare (HVAD) device exchanges. METHODS: A retrospective review of 11 patients who underwent HMII to HVAD exchange from 2012 to 2017 was conducted to evaluate patient characteristics, incidence of postoperative complications, and survival. RESULTS: Eleven male patients (mean age 55 ± 14.4 years) underwent HMII to HVAD device exchange. One patient expired on postoperative day 7 secondary to sepsis. One patient was lost-to-follow-up after 23 months. An additional three patients died at 5, 7, and 24 months. Mean follow-up after device exchange was 1555 ± 311 days for the remaining six patients. None of the 11 study patients underwent LVAD explant, further device exchange, or heart transplant. CONCLUSION: Exchange of an HMII LVAD to an HVAD can be performed safely with acceptable perioperative morbidity and mortality.

Donation After Cardiac Death: A Necessary Expansion for Heart Transplantation.

The gold standard and sole curative therapy for advanced stage heart failure is cardiac transplantation. As the population ages, the number of patients diagnosed with advanced heart failure and listed for transplant steadily increases annually. However, there remains a paucity of eligible donation after brain death (DBD) donor hearts which severely limits access to cardiac transplantation and leads to increasing wait-list times and avoidable patient mortalities. Though the first human heart transplant in 1967 was performed using a deceased donor heart, the advent of brain death criteria and the ability to avoid long warm ischemic times led donation after cardiac death (DCD) transplantation to fall out of favor. Due the current state of cardiac transplantation, there has been a resurgence in interest in DCD heart transplantation leading to the development of DCD heart transplantation programs in the UK and Australia after positive reports of successful DCD cardiac transplantation in the pediatric literature. These programs have demonstrated favorable post-transplantation outcomes equivalent to matched traditional DBD transplants with current techniques and strict donor criteria. This technique has been proven safe with favorable outcomes and has been demonstrated to significantly increase transplant volumes and decrease patient mortality. Given these outcomes and the high patient benefit to risk ratio, DCD donor heart transplantation is necessary to expand the donor pool and decrease patient mortality and should be developed in high volume experienced cardiac transplant centers.

Total artificial heart implantation as a bridge to transplantation: a viable model for the future?

INTRODUCTION: Since the first total artificial heart (TAH) surgery in a human patient performed in 1969, over 1300 devices have been implanted worldwide. Patients are benefiting from increased lengths of durable support and indications have expanded beyond biventricular failure including allograft failure, severe restrictive disease, and complex congenital anomalies. Areas covered: The role of the TAH in biventricular failure, rates of successful bridge-to-transplant (BTT), and survival compared with biventricular assist devices (BiVADs) are discussed and differences between TAH and LVAD patient populations are highlighted. The device's niche role in physiologies not amenable to single ventricle support is further described. New developments such as the 50cc Syncardia, continuous flow mechanisms (BiVACOR and Cleveland Clinic CF-TAH), and a bioprosthetic model (CARMAT) are discussed. Literature review was conducted utilizing the PubMed database selecting published research, database analyses, and case reports under 'total artificial heart' relevant to the paper's aims. Expert commentary: TAH patients have high rates of successful BTT and survival on par with BiVAD-supported patients. Ongoing developments including decreased device size, continuous flow mechanisms, and use of bioprosthetic materials will ensure that the TAH will have an increasing role in advanced heart failure with increased device longevity and decreased post-implant complications.