title: Perioperative blood product use: a comparison between HeartWare and HeartMate II devices.
abstract: BACKGROUND
  The HeartWare (HW) (Framingham, MA) and the HeartMate II (HM II) (Thoratec Inc, Pleasanton, CA) continuous-flow left ventricular assist devices (CF-LVADs) are commonly used to bridge patients to transplantation. We hypothesized that there are differences in perioperative blood product (BP) use and chest tube (CT) output between CF-LVAD types.
  
  
  METHODS
  We retrospectively evaluated BP use in 71 patients who were implanted with a CF-LVAD (HM II = 38; HW = 33) by median sternotomy for bridge to transplantation (BTT) indications from 2009 to 2013. Detailed BP use data were collected during the intraoperative and postoperative periods and included packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitate.
  
  
  RESULTS
  Preoperative characteristics (age, left ventricular ejection fraction, previous sternotomy, ischemic cause), and risk stratification scores (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS]) profile, Leitz-Miller score, Kormos score) were comparable between groups (all p > 0.05). Total average intraoperative and postoperative BP use was different between device types: HW = 8.3 ± 13 versus HM II = 12.6 ± 14.0 units (p = 0.002) and HW = 6.1 ± 12.0 units compared with HM II = 13.5 ± 24.1 units (p = 0.022), respectively. Average postoperative CT output for HW (3,231 ± 3,648 mL) and HM II (3,463 ± 3,050) (p < 0.008) were different between device types. Multivariate analysis revealed that a higher preoperative Leitz-Miller score, implantation of an HM II CF-LVAD, previous sternotomy, and a longer duration of cardiopulmonary bypass (CPB) time were independently associated with increased need for BP use, whereas only use of the HM II device and a longer bypass time predicted a greater CT output.
  
  
  CONCLUSIONS
  Compared with HM II, implantation of the HW CF-LVAD was associated with reduced intraoperative and postoperative BP use and decreased CT output. Increased awareness of device-related differences in bleeding and BP use may improve CF-LVAD patient outcomes.
authors.affiliation: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Haglund
authors.affiliation: Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Davis
authors.affiliation: Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tricarico
authors.affiliation: Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Rashid M
authors.initials: RM
authors.lastname: Ahmad
authors.affiliation: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: DiSalvo
authors.affiliation: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Keebler
authors.affiliation: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Schlendorf
authors.affiliation: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Wigger
authors.affiliation: Department of Cardiothoracic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.affiliation: Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: simon.maltais@vanderbilt.edu.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006353:Heart-Assist Devices / Q000145:classification*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors