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DOI: 10.1055/s-0032-1332343
Destination therapy with magnetically levitated pumps – the next major widespread advance in heart failure therapy?
Introduction: Destination therapy (DT) with mechanical circulatory support (MCS) for advanced-stage heart failure patients is an alternative therapy in patients not eligible for cardiac transplantat. New generation magnetically levitated pumps encourage a broader use of DT. Aim of this study was to analyze the problems and outcome after DT with MCS.
Methods: 15 consecutive patients at our hospital were included in this study. Only adult patients with magnetically levitated pump LVADs (Heartware®, INCOR®, new INCOR®) were included. We analyzed the indication and outcome of LVAD destination therapy assessing risk profile, INTERMACS classification, complication rates, and survival after LVAD implantation (cut-off 31/08/2012).
Results: 8 out of 15 patients were provided with the Heartware®-LVAD, 7 others were provided with BerlinHeart INCOR®-LVAD. Our data showed comparable preoperative values including age [65.1 y ± 5.1 y (Heartware) vs. 67.1 y ± 10.1 y (INCOR)] and INTERMACS classification [3 ± 0.9% (Heartware) vs. 2.9 ± 1.4% (INCOR)]. The indication for DT includes advanced age, compliance problems, previous tumor history and severe comorbidities. Outcome data demonstrate a low 30-day mortality (6.7% mortality) and a high 1 year survival rate of 93.3% (Kaplan-Meier 1 y survival) in elective DT patients. Mean follow up after permanent Heartware implantation was in average 367 days (range, 10 – 844) and 642 days (range, 2 – 2538) for permanent INCOR implantations respectively. 3 patients died after DT within 13 – 776 days. 1 of them due to new onset of gynaecological tumour. Most frequent complications include bleeding and stroke (1 GI-bleeding, 2 new onsets of permanent stroke, 1 PRIND, 1 recovered from SAB, 1 sternal wound infection). Using Heartware and INCOR with new software lead to reduction of required INR and hereby reduction of complication rate.
Conclusion: Destination therapy with magnetically levitated pumps is associated with lower in-hospital mortality compared to heart transplant patients. Long-term survival after destination therapy is possible. Especially new magnetically levitated pumps with lower INR required might help to further reduce LVAD complications.