LVAD, heart failure journey continues

Introduction Heart failure (HF) is a global pandemic affecting at least 26 million people worldwide and is increasing in prevalence (1). Heart transplantation or implantation of durable mechanical circulatory support (MCS) are the sole therapies available for end-stage heart failure. Such patients have severely impaired systolic ventricular function due to end-stage cardiomyopathies but remain symptomatic despite optimal guideline-recommended treatment (2). Acute MCS can be effectively employed as a bridge to long-term MCS devices and heart transplantation. Heart transplantation has been limited by diminishing donor heart availability leading to a greater role of left ventricular assist device (LVAD) support. Methods Retrospective review of adult patients supported with HeartWare™ HVAD™ Pump as a first long term LVAD between January 2017 and February 2020. Results 73 patients received LVADs at our institution in that period. 59 (80%) males, 14 (20%) females, mean age 50. The most common indications were dilated (40%) and ischaemic (34%) cardiomyopathies. 27% of devices were implanted via sternotomy vs 76% via anterolateral thoracotomy. The most frequent complications were driveline infection 26 (36%), pump thrombosis 18 (25%) and ischaemic stroke 16 (22%). Overall, 30 days survival on LVAD was 85% and 1 year survival 65%. 1-year survival in the thoracotomy group was significantly greater compared to the sternotomy group 72% vs 49%, and less red cell transfusion rate (5.2 vs 9.8 units) in thoracotomy approach group was observed. 4 (5.5%) patients received heart transplant. Discussion Despite the excellent long-term survival data for heart transplantation, patients who are denied a transplant or who will not survive the long high-urgency waiting time, benefit more from a permanent LVAD and achieve outpatient status with acceptable quality of life for a reasonable period of time. The minimally invasive surgical approach implemented at our centre is associated with fewer mediastinal adhesions at time of transplant, which greatly facilitates heart implantation and reduces donor organ ischemic time resulting in improved graft performance (3). With new technology focused on limitations of the most common LVAD complications, implanted via thoracotomy, MCS remains valuable treatment tool and it might potentially play more important role in the future of the HF patients.