Treatment of device XXXX in the HeartWare HVAD: Success and outcomes depend significantly on the initial treatment strategy.

@entity1 @entity64 @entity6950 @entity715 @entity204
BACKGROUND: Pump @entity715 is a major adverse event in @entity1 supported with a left ventricular assist device (LVAD). Treatment approaches include device exchange, lytic therapy, or augmentation of anticoagulation or antiplatelet therapy. The optimal strategy in the HeartWare HVAD Ventricular Assist System (HeartWare, Framingham, MA) is uncertain, and because few large studies have examined differing treatment outcomes, we have reviewed findings from the Mechanical Circulatory Support Research Network registry. METHODS: Between March 2009 and August 2014, 175 @entity1 (133 male) underwent implantation of the HeartWare HVAD at institutions that comprise the Mechanical Circulatory Support Research Network. Median age at implant was 59 years (range, 18-76 years). Follow-up was available in all @entity1 for a median of 6 months (maximum, 61 months) and for a total of 163 @entity1 -years of support. There were 36 pump @entity715 (using Interagency Registry for Mechanically Assisted Circulatory Support criteria) in 21 @entity1 for a total event rate of 0.22 events/ @entity1 -year of support; 13 @entity1 had 1 event, 4 had 2, 2 had 3, 1 had 4, and 1 had 5. The median time to the first @entity715 was 6.4 months, and to each subsequent @entity715 was 4, 3, 2, and 2 months, respectively. Primary treatment success was defined as the @entity1 remaining alive and within the first 30 days of the initial treatment be free from @entity64 , recurrence of pump @entity715 , device exchange, or urgent transplantation (United Network of Organ Sharing Status 1A). Medical treatment was defined as tissue plasminogen activator, @entity6950 plus glycoprotein IIb/IIIa inhibitor, or @entity6950 alone, not followed by surgical treatment within 72 hours. RESULTS: Initial medical treatment was used in 29 episodes (tissue plasminogen activator in 24, @entity6950 alone in 4, and @entity6950 plus glycoprotein IIb/IIIa in 1) and surgical (device exchange) in 7. Medical treatment was successful in 14 of 29 episodes (48%). Complications of medical treatment included @entity64 in 6 @entity1 (21%), need for urgent device exchange/transplant in 6 (21%), and @entity204 in 3 (10%). Surgical treatment was successful in all 7 @entity1 (100%). No significant early complications or early @entity204 occurred after device exchange. CONCLUSIONS: In this large multicenter analysis, we observed that medical therapy, as the initial treatment strategy for HeartWare HVAD @entity715 , is associated with low success (48%) and a significant risk of @entity64 (21%) and @entity204 (10%). However, initial treatment with device exchange was uniformly successful and not associated with significant early morbidity or @entity204 . Although the optimal treatment approach for HeartWare HVAD pump @entity715 remains undecided, these data do not support the routine use of medical therapy as an initial treatment strategy.
