The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support
Abstract
:1. History and Survival Outcomes
1.1. Transition to Continuous-Flow Devices
1.2. Third-Generation Devices
1.3. Real-Life Outcomes from Observational Studies
2. Patient Management and Optimization
2.1. Patient Selection
2.1.1. Medical Evaluation
2.1.2. Psychosocial Considerations in Patient Selection and Quality of Life
2.2. Surgical Management
2.2.1. General Considerations for LVAD Configuration
2.2.2. Considerations for Destination Therapy versus Bridge to Transplant LVAD Implantation
2.3. Medical Management to Minimize Adverse Events
2.3.1. Stroke
2.3.2. Right Ventricular Failure
2.3.3. Gastrointestinal Bleeding
2.3.4. Driveline Infections
3. Future Directions
Author Contributions
Funding
Conflicts of Interest
References
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Laboratory Test | High Risk Features | Contraindications | |
---|---|---|---|
Cardiac Evaluation | |||
Right heart catheterization |
| ||
Trans-thoracic echocardiogram |
| ||
Left heart catheterization |
| ||
Electrocardiogram |
| ||
Cardiopulmonary exercise test |
| ||
Non-cardiac evaluation | |||
Renal | Basic metabolic panel |
| Hemodialysis |
Gastrointestinal | EGD/Colonoscopy |
| Malignancy with poor 5-year survival |
Hepatic | Liver panel, liver ultrasound If needed to rule out cirrhosis: liver biopsy, portal pressure measurement |
| Chronic liver disease with bilirubin > 3 g/dl, Evidence of cirrhosis MELD > 17 |
Hematology | CBC, coagulation panel, HIT panel in selected patients |
| |
Oncology | Age-appropriate screening tests |
| Active malignancy |
Vascular | Vascular ultrasound Ankle-brachial index |
| |
Pulmonary | Pulmonary function test Lung imaging |
| |
Infectious disease | Microbiology tests and imaging depending on the patient’s history and physical exam |
| Active infection |
Endocrine | TSH HbA1c |
| |
Nutrition | Albumin, pre-albumin |
| |
Neurologic | CT head or MRI head Neurocognitive evaluation |
| Substantial neurologic deficits or neurocognitive disabilities impairing functional status |
Dental | X-ray or CT if indicated |
| |
Psychosocial | |||
SIPAT score Comprehensive psychosocial and substance abuse history |
| Poor psychosocial profile with no viable plan for improvement in a relative short timeframe, lack of stable housing, at risk of incarceration |
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Berardi, C.; Bravo, C.A.; Li, S.; Khorsandi, M.; Keenan, J.E.; Auld, J.; Rockom, S.; Beckman, J.A.; Mahr, C. The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support. J. Clin. Med. 2022, 11, 2022. https://doi.org/10.3390/jcm11072022
Berardi C, Bravo CA, Li S, Khorsandi M, Keenan JE, Auld J, Rockom S, Beckman JA, Mahr C. The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support. Journal of Clinical Medicine. 2022; 11(7):2022. https://doi.org/10.3390/jcm11072022
Chicago/Turabian StyleBerardi, Cecilia, Claudio A. Bravo, Song Li, Maziar Khorsandi, Jeffrey E. Keenan, Jonathan Auld, Sunny Rockom, Jennifer A. Beckman, and Claudius Mahr. 2022. "The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support" Journal of Clinical Medicine 11, no. 7: 2022. https://doi.org/10.3390/jcm11072022