Subscribe to RSS
DOI: 10.1055/s-0034-1367367
HeartWare® Assist Device - Infections, bleedings, and thrombosis dominate morbidity and mortality
Objective: The increasing number of patients (pts) awaiting heart transplantion and the shortage of donors led to the development of ventricular assist devices (VAD). We analysed our experience with the Heart Ware® HVAD in order to evaluate complications during follow-up (FU).
Patients: The data were drawn from our institution's database on 38 pts implanted with a HVAD between January 2010 and August 2013. The mean patient age was 57 ± 12 years. Indication for implantation was DCM (16 pts), ICM (12), postcardiothomy heart failure (4), myocarditis (3), and acute heart failure after myocardial infarction (3). Twenty pts (53%) were dependent on intravenous inotropes, 10 pts (26%) had an IABP implanted, and 7 (18%) were on ECMO. The mean cardiac index was 1.8l/min/m2.
Results: Hospital mortality was 18% (7 pts). Cause of death was septic multi-organ failure (MOF) in 3 cases and hemorrhagic MOF in 4. Late mortality (after 3 months) accounted for 10 deaths (26%) with 6 infections (2 VAD infections, 4 pneumonias), 1 VAD thrombosis, and 3 accidental disconnections of the driveline. Two of 6 pts with bleeding from the gastrointestinal tract (GIT) developed it in the early postoperative episode and died. In the late FU bleeding from GIT occurred frequently (0.23 events per pts-year), but could be controlled by optimization of anticoagulation or endoscopic haemostasis in all cases. During the late FU, 4 VAD thromboses were observed. In 1 case, thrombolysis was successful. Two devises completely stopped and pts required surgery. One VAD was explanted and the other pt died in cardiogenic shock before the surgery. During a mean FU of 10 ± 7 months, 8 pts developed infections. Two pts underwent heart transplantation. In 4 pts, infections were eradicated with antibiotics and in 2 cases, infections led to sepsis and the pts died. Four pts developed ischemic and 3 pts hemorrhagic strokes. Six pts suffered stroke in late FU period. No pt died of stroke, but 5 pts retained neurological deficits. Seventeen pts are still on the device. Mean time of assistance was 247 ± 15 days. In this period we had no cases of device malfunction.
Conclusion: Bleeding from GIT and infections were frequent complications during early and late FU. Stroke and VAD thrombosis more commonly occurred after the first 3 months of assistance. Totally implantable VADs with transcutaneous energy transfer should reduce the infectious complications and thus morbidity.