1
|
Mihalj M, Heinisch P, Schober P, Dobner S, Fuerholz M, Martinelli M, Hugi-Mayr B, De By T, Mohacsi P, Schefold J, Luedi M, Kadner A, Carrel T, Hunziker L, Reineke D. Third generation continuous flow left ventricular assist devices; a comparative outcome analysis by device type. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Continuous-flow left ventricular assist devices (CF-LVADs) have become a standard of care in end-stage heart failure (HF). Device-related complications remain high. Limited data exists comparing outcomes of the HeartMate 3 (HM3) and the HeartWare HVAD (HW). We aimed to analyze HM3 and HW devices implanted over the past 10 years with a focus on long-term clinical outcomes of respective patients.
Methods
Investigator-initiated comparative, retrospective observational analysis of all patients who underwent primary implantation of a centrifugal CF-LVAD at our tertiary care academic center between January 2010 and December 2020. Data derived from a prospective registry, and included all patients receiving a HM3 or HW device. Primary endpoint was overall (all-cause) mortality and heart transplantation. Secondary endpoints included device-related major adverse cardiac and cerebrovascular events (MACCE), as well right heart failure (RHF), gastrointestinal (GI) bleeding, driveline infections, and surgical re-interventions.
Results
Out of 106 primary CF-LVAD implantations, 36 (34%) received HM3 and 70 (66%) received HW. Median follow-up time was 1.48 years [interquartile range 0.67, 2.41] and did not differ between devices (p=0.739). HM3 was more often implanted in men (91.7% vs. 72.9%, p=0.024), patients were older (median 61 years [54, 66.5] vs. 52.5 years [43, 60], p<0.001), had a higher body mass index (BMI) (median 26.7 kg/m2 [23.4, 29.0] vs. 24.3 kg/m2 [20.7, 27.4], p=0.013), had more comorbidities and were more likely targeted for destination therapy (DT) (36.1% vs. 14.3%, p=0.010). Death occurred in 33.3% of HM3 patients, compared to 22.9% of HW patients, p=0.247 (probability of survival at 2 years 54.7% vs. 74.1%, p=0.296). After adjustment for confounders, we observed a significant 6-fold risk increase in device malfunctions for HW (hazard ratio (HR) 6.49, 95% CI [1.89, 22.32], p=0.003), but no significant differences between devices in pump thrombosis (p=0.173) or overall survival (p=0.801).
Conclusions
Comparing long-term outcomes between HeartMate 3 and HeartWare HVAD for LVAD support from a prospective registry, HeartWare HVAD patients had a significantly higher risk of device malfunctions. No significant differences were evident between devices in overall survival, and in respect to most clinical outcomes.
Funding Acknowledgement
Type of funding sources: None. KM Plot primary and secondary outcomesRisk analysis on all outcomes
Collapse
Affiliation(s)
- M Mihalj
- Bern University Hospital, Inselspital, Department of Cardiovascular Surgery, Bern, Switzerland
| | - P.P Heinisch
- Bern University Hospital, Inselspital, Department of Cardiovascular Surgery, Bern, Switzerland
| | - P Schober
- Vrije Universiteit Medical Center (VUMC), Department of Anaesthesiology, Amsterdam, Netherlands (The)
| | - S Dobner
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - M Fuerholz
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - M Martinelli
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - B Hugi-Mayr
- Bern University Hospital, Inselspital, Department of Cardiovascular Surgery, Bern, Switzerland
| | | | - P Mohacsi
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - J.C Schefold
- Bern University Hospital, Inselspital, Department of Intensive Care Medicine, Bern, Switzerland
| | - M.M Luedi
- Bern University Hospital, Inselspital, Department of Anesthesiology and Pain Medicine, Bern, Switzerland
| | - A Kadner
- Bern University Hospital, Inselspital, Department of Cardiovascular Surgery, Bern, Switzerland
| | - T Carrel
- Bern University Hospital, Inselspital, Department of Cardiovascular Surgery, Bern, Switzerland
| | - L Hunziker
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - D Reineke
- Bern University Hospital, Inselspital, Department of Cardiovascular Surgery, Bern, Switzerland
| | | |
Collapse
|
2
|
Galea R, Räber L, Fuerholz M, Häner JD, Siontis GCM, Brugger N, Moschovitis A, Heg D, Fischer U, Meier B, Windecker S, Valgimigli M. Impact of Echocardiographic Guidance on Safety and Efficacy of Left Atrial Appendage Closure: An Observational Study. JACC Cardiovasc Interv 2021; 14:1815-1826. [PMID: 34412799 DOI: 10.1016/j.jcin.2021.05.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of echocardiographic guidance on the safety and efficacy of left atrial appendage closure (LAAC). BACKGROUND Expert consensus documents recommend intraprocedural imaging by means of either transesophageal echocardiography or intracardiac echocardiography to guide LAAC. However, no evidence exists that intraprocedural echocardiographic guidance in addition to fluoroscopy improves the safety and efficacy of LAAC. METHODS Consecutive LAAC procedures performed at a high-volume center between January 2009 and October 2020 were stratified on the basis of intraprocedural imaging modalities, including fluoroscopic guidance (FG) only or intraprocedural echocardiographic guidance (EG) in addition to fluoroscopy. The primary safety endpoint was the composite of procedure-related complications occurring within 7 days after the procedure. Technical success at 7 days and at follow-up were secondary endpoints. RESULTS Among 811 LAAC procedures, 549 (67.7%) and 262 (32.3%) were assigned to the FG and EG groups, respectively. After adjusting for confounders, EG remained associated with a lower rate of the primary safety endpoint (3.4% vs 9.1%; P = 0.004; adjusted odds ratio [OR]: 0.31; 95% CI: 0.11-0.90; P = 0.030). Technical success trended higher at 7 days (92.1% vs 87.2%; P = 0.065; adjusted OR: 1.68; 95% CI: 0.95-3.01; P = 0.079) and was significantly improved with EG compared with FG (87.6% vs 79.9%; P = 0.018; OR: 4.06; 95% CI: 1.60-10.27; P = 0.003) after a median follow-up period of 4.9 months (interquartile range: 3.4 months-6.2 months). CONCLUSIONS In a large cohort of consecutive LAACs, the use of intraprocedural echocardiography to guide intervention in addition to standard fluoroscopy was associated with lower risks for procedural complications and higher mid-term technical success rates.
Collapse
Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Fuerholz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aris Moschovitis
- Department of Cardiology, HerzZentrum Hirslanden, Zürich, Switzerland
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
| |
Collapse
|
3
|
Kleinecke C, Fuerholz M, Buffle E, de Marchi S, Schnupp S, Brachmann J, Nietlispach F, Fankhauser M, Streit SR, Windecker S, Meier B, Gloekler S. Transseptal puncture versus patent foramen ovale or atrial septal defect access for left atrial appendage closure. EUROINTERVENTION 2020; 16:e173-e180. [PMID: 31449043 DOI: 10.4244/eij-d-19-00442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to compare the periprocedural and late clinical outcomes of left atrial appendage closure (LAAC) with AMPLATZER devices by access through transseptal puncture (TSP) versus a patent foramen ovale (PFO) or an atrial septal defect (ASD). METHODS AND RESULTS Between 2009 and 2018, 578 consecutive patients underwent LAAC via TSP or PFO/ASD access in three centres. After a 3:1 propensity score matching, 246 (TSP) versus 91 (PFO/ASD) patients were compared using the primary efficacy endpoint of all-cause stroke, systemic embolism and cardiovascular/unexplained death and the primary safety endpoint of major periprocedural complications and major bleedings at follow-up. Mean age was 75.2±8.7 (TSP) vs 74.4±10.9 (PFO/ASD) years, CHA2DS2-VASc score 4.5±1.6 vs 4.3±1.4 and HAS-BLED score 3.3±1.0 vs 3.3±0.9. Device success (97.6% vs 97.8%, p=0.90) was similar. After 2.5±1.4 vs 2.6±1.6 years, clinical efficacy (46/603, 7.6% [TSP] vs 21/233, 9.0% [PFO/ASD], hazard ratio [HR] 1.2; 95% confidence interval [CI]: 0.69-0.85, p=0.54) and safety (24/603, 4.0% vs 11/233, 4.7%; HR 1.4; 95% CI: 0.52-3.6, p=0.49) did not differ. CONCLUSIONS Use of a PFO/ASD access for LAAC with AMPLATZER devices offers similar periprocedural and late clinical outcomes to TSP. Simultaneous PFO/ASD closure for an additional protective benefit does not increase risk.
Collapse
|
4
|
Kleinecke C, Yu J, Neef P, Buffle E, de Marchi S, Fuerholz M, Nietlispach F, Valgimigli M, Streit SR, Fankhauser M, Duenninger E, Windecker S, Meier B, Gloekler S. Clinical outcomes of Watchman vs. Amplatzer occluders for left atrial appendage closure (WATCH at LAAC). Europace 2020; 22:916-923. [DOI: 10.1093/europace/euaa001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/05/2020] [Indexed: 12/16/2022] Open
Abstract
Abstract
Aims
This study compares clinical outcomes of Watchman vs. Amplatzer devices for left atrial appendage closure (LAAC).
Methods and results
Of two real-world registries, the Watchman registry Lichtenfels, Germany, and the Amplatzer registry Bern-Zurich, Switzerland, 303 and 333 consecutive patients, respectively, were included. After a 1:1 propensity score matching, 266 vs. 266 patients were compared by use of the predefined primary efficacy endpoint of stroke, systemic embolism and cardiovascular/unexplained death, the primary safety endpoint of major peri-procedural complications and major bleeding events at follow-up, and the combined hazard endpoint, a composite of all above-mentioned hazards. Mean age was 75.3 ± 7.8 (Watchman) vs. 75.1 ± 9.9 (Amplatzer) years, CHA2DS2-VASc score 4.5 ± 1.7 vs. 4.5 ± 1.5, and HAS-BLED score 3.2 ± 1.0 vs. 3.2 ± 1.0. At a mean follow-up of 2.4 ± 1.3 vs. 2.5 ± 1.5 years and 1.322 patient-years, the primary endpoints of efficacy [40/646, 6.2% [Watchman] vs. 43/676, 6.4% [Amplatzer]; hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.66–1.58; P = 0.92] and safety (33/646, 5.1% vs. 30/676, 4.4%; HR, 0.57; 95% CI, 0.29–1.11; P = 0.10), as well as the combined hazard endpoint (69/646, 10.7% vs. 66/676, 9.8%; HR, 0.80; 95% CI, 0.55–1.12; P = 0.26) were similar for both groups.
Conclusion
This study suggests comparable efficacy and safety of the Watchman and Amplatzer devices.
Collapse
Affiliation(s)
- Caroline Kleinecke
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Jiangtao Yu
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Philip Neef
- Department of Cardiology, Schwarzwald-Baar Klinikum, Klinikstraße 11, 78052 Villingen-Schwenningen, Germany
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Eric Buffle
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Stefano de Marchi
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Monika Fuerholz
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
- Cardiovascular Center Zurich, Hirslanden Klinik Im Park, Zurich, Switzerland
| | - Marco Valgimigli
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Samuel R Streit
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Mate Fankhauser
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Erich Duenninger
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Stephan Windecker
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Schwarzwald-Baar Klinikum, Klinikstraße 11, 78052 Villingen-Schwenningen, Germany
| |
Collapse
|
5
|
Haener J, Fuerholz M, Cherni T, Koskinas K, Piccolo R, Streit S, Praz F, Shakir S, Attinger-Toller A, Nietlispach F, Valgimigli M, Meier B, Windecker S, Gloekler S. P4891Procedural safety and long-term clinical outcome of left atrial appendage closure according to predefined stroke risk. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|