Continuous‐flow LVAD exchange to a different pump model: Systematic review and meta‐analysis of the outcomes

Autor:	John W. Entwistle, Melissa A. Austin, Rene Alvarez, Vakhtang Tchantchaleishvili, Rohinton J. Morris, H.T. Massey, Marc N Gadda, Thomas J. O'Malley, Elizabeth J. Maynes, Preethi Pirlamarla, Mahek Shah
Rok vydání:	2021
Předmět:	medicine.medical_specialty 0206 medical engineering Biomedical Engineering Medicine (miscellaneous) Bioengineering 02 engineering and technology 030204 cardiovascular system & hematology Infections Biomaterials 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Stroke Device Removal Heart Failure Ischemic cardiomyopathy Heartmate ii Continuous flow business.industry Thrombosis General Medicine medicine.disease 020601 biomedical engineering Right Ventricular Assist Device Meta-analysis Heart failure Cardiology Equipment Failure Heart-Assist Devices business
Zdroj:	Artificial Organs. 45:696-705
ISSN:	1525-1594 0160-564X
Popis:	Despite improved outcomes of modern continuous-flow left ventricular assist devices (CF-LVADs), device exchange is still needed for various indications. While the majority of CF-LVADs are exchanged to the same model, exchange to a different pump model is occasionally warranted. In this meta-analysis, we sought to consolidate the existing evidence to better elucidate the indications and outcomes in these cases. A comprehensive systematic search of adult patient cohorts who underwent CF-LVAD exchange to a different CF-LVAD model was performed. Study-level data from 10 studies comprising 98 patients were extracted and pooled for analysis. Mean patient age was 58 (95% CI: 48-65) and 81% were male. Indication for initial CF-LVAD was ischemic cardiomyopathy in 45% (34-57). Initial device was HeartMate II LVAD (HMII) in 93 (94.9%) and HeartWare HVAD (HW) in 5 (5.1%) patients. After mean CF-LVAD support time of 18.8 (15.2-22.4) months, exchange indications included thrombosis in 71% (43-89), infection in 21% (8-47) and device malfunction in 12% (7-21). HMII to HW exchange occurred in 53 (54.1%) patients, HMII to HeartMate III (HM3) in 32 (32.7%), and HM II to either HW or HM3 in 13 (13.2%) patients. Postoperatively, right ventricular assist device was required in 16% (8-32). Overall, 20% (8-40) of patients experienced a stroke, while HW patients had a significantly higher stroke incidence than HM3 patients (HW: 21% (8-47) vs. HM3: 5% (1-24), P < .01). Overall 30-day mortality was 10% (6-17), while HW had a significantly worse 30-day mortality than HM3 (HW: 13% (7-24) vs. HM3: 5% (1-24), P = .03). Following device exchange from a different CF-LVAD model, HM3 is associated with lower stroke and higher survival when compared to HW.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::97854726c47952e36c2123f7da8aa242 https://doi.org/10.1111/aor.13893 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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