Right atrial versus right ventricular HeartWare HVAD position in patients on biventricular HeartWare HVAD support: A systematic review
| Autor: | Thomas J. O’Malley, John W. Entwistle, Vakhtang Tchantchaleishvili, Kyle W. Prochno, Chelsey T. Wood, Preeyal M. Patel, Jae Hwan Choi, Elizabeth J. Maynes, H. Todd Massey, Rohinton J. Morris |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
GI bleeding Heart Ventricles Ventricular Dysfunction Right 0206 medical engineering Biomedical Engineering Medicine (miscellaneous) Bioengineering Kaplan-Meier Estimate 02 engineering and technology 030204 cardiovascular system & hematology Right atrial Prosthesis Implantation Biomaterials Ventricular Dysfunction Left 03 medical and health sciences 0302 clinical medicine Right heart failure Patient age Internal medicine medicine Humans In patient Heart Atria Pump thrombosis Heart Failure business.industry General Medicine 020601 biomedical engineering Treatment Outcome Median time Concomitant Cardiology Heart-Assist Devices business |
| Zdroj: | Artificial Organs. 44:926-934 |
| ISSN: | 1525-1594 0160-564X |
| Popis: | In patients with biventricular heart failure or refractory right heart failure following HeartWare HVAD placement, off-label placement of a right-sided HeartWare HVAD has been described both in the right ventricular (RV) and right atrial (RA) positions. We sought to evaluate and compare the outcomes of right-sided HeartWare HVAD using the RA versus RV approach. An electronic search was performed in the English literature to identify all reports of left- and right-heart support with HeartWare HVAD. Of the 1,288 articles identified, 13 articles with 56 cases met inclusion criteria. Patient-level data were extracted and analyzed. The median patient age was 52 years (IQR 33.0-59.0) and 40/50 (80.0%) were male. Overall, 21/56 patients (37.5%) had RA HVAD, while 35/56 (62.5%) had RV HVAD. Most underwent concomitant HVAD placement [RA: 17/21 (81.0%) vs. RV: 31/35 (88.6%), P = .69]. In those who did not, the median time between left and right HVAD was 10 days (IQR 7-14) for RA HVAD and 12 days (IQR 8-30) for RV HVAD (P = .77). The median time of support was 351 days (IQR 136-626) for RA HVAD compared to 135 days (IQR 61-244) for RV HVAD (P = .02). Pump thrombosis occurred at a similar rate [RA: 3/10 (30.0%) vs. RV: 6/20 (30.0%), P = 1], as did GI bleeding [RA: 10/35 (28.6%) vs. RV: 5/21 (23.8%), P = .94] during the follow-up time period. Kaplan-Meier analysis when censored for transplant showed higher survival with RA HVAD compared to RV HVAD (P = .036), with an estimated survival at 1 year of 91.7% (95% CI 77.3-100.0) in RA HVAD versus 66.2% (95% CI 48.9-89.6) for RV HVAD. RA HVAD appears to be a viable option for durable right-sided support with outcomes at least comparable to RV HVAD. |
| Databáze: | OpenAIRE |
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