Multicenter Canadian Experience with the HeartWare HVAD

Abstract

Purpose The HeartWare HVAD is a third generation centrifugal pump that has recently completed a US bridge to transplant clinical trial. The device is available in Canada under the Special Access Program since 2010. We describe our multicenter experience with this device. Methods and Materials We collated the cumulative experience with the HVAD device at 5 centers (Vancouver General, Toronto General, University of Alberta, St Boniface Hospital and Queen Elizabeth II). Followup was 100% complete until death, transplant or explant and consisted of 75 patients supported for an average of 219 + 200 days (range 1-842 days). Results The average age was 51 + 14 years (range 6-72) with 33 females and 42 males. Eleven patients (15%) were over the age of 65. There were 5 deaths within 30 days (7%) and a total of 10 deaths (13%). 26 pts were successfully bridged to transplant (n=24) or explant (n=2) while 39 pts remain under HVAD support (52%). A total of 11 patients have been supported for over one year with 3 patients supported >2 years. In the elderly cohort, 8 patients remain supported with 2 deaths and 1 successful transplant. Two patients in the entire cohort suffered from pump thrombosis of which one underwent successful thrombolysis while the other underwent successful pump exchange. There were 7 patients (9%) who suffered from GI bleeds and 16 patients (21%) who suffered from a neurologic complication. Only 2 of 11 elderly patients suffered from a stroke. Conclusions Our multicenter Canadian report represents “real-world” clinical experience with the HeartWare HVAD. The results are strikingly similar to those reported in the ADVANCE trial with the exception of a higher rate of neurologic complications. The GI bleeding rate appears to be lower than the trial report, suggesting that anticoagulation parameters may have been lower in this experience. These data continue to support the use of the HVAD in Canadian centers and the low rate of pump malfunction supports its use in non-transplant eligible patients who require prolonged periods of circulatory support.