TORONTO GENERAL HOSPITAL EXPERIENCE WITH CONTINUOUS FLOW LVADS: A COMPARISON BETWEEN HEARTMATE II AND HEARTWARE HVAD

The HeartWare (HW) HVAD device is a newer generation of centrifugal flow ventricular assist device (VAD) which has been recently introduced in Canada. The objective of our study was to evaluate outcomes in patients supported with a HW device in comparison to patients supported with a HeartMate II (HMII) axial flow device. Forty-six patients underwent VAD implantation from 2006 to April 2012 at our institution, HMII device was implanted in 33 patients and 13 patients received a HW device. Patient characteristics pre-VAD implant, incidence of complications during support and survival between groups were compared. Overall baseline characteristics, hemodynamic profile and laboratory values prior to VAD implantation were similar between groups, except that the proportion of females was higher in HW patients (76% vs. 24% in HMII patients, p<0.01). Most of the patients were INTERMACS 3-4 (92% in both groups) and received the device as a bridge-to-transplant (75% in HMII vs. 79% in HW). The incidence of infection, liver failure, renal failure, bleeding and right ventricular failure post-VAD implantation were similar between groups. However, higher proportion of HW patients had an episode of gastro-intestinal bleeding (31% vs. 0% in HMII patients, p<0.01) and a stroke (39% vs. 9% in HMII patients, p=0.03) during support. Hemorrhagic strokes were more frequent in HW patients (3 of the 5 episodes vs. 1 of the 3 episodes of stroke in HMII patients, p=0.06). Duration of VAD support was similar between groups; 18 HMII patients and 4 HW patients underwent transplantation during support (p=0.15). Mortality at 30 days and 1-year survival were similar between groups (8% in HW vs. 12% in HMII, p=0.66; and 75% in HW patients vs. 82% in HMII patients, p=0.91; respectively). Based on our center's experience, HW device offers similar survival benefit that patients supported with HMII. The use of HW was associated with higher incidence of stroke and gastrointestinal bleeding. Refinement in patients' management may decrease the incidence of these complications.