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Urgent exchange of a HeartMate II left ventricular assist device after percutaneous lead fracture
Mehdi Jafar1, Igor D Gregoric, Rajko Radovancevic
1Center for Cardiac Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA.
Insights
Patient education is crucial for HeartMate II left ventricular assist device (LVAD) recipients to prevent driveline kinking and lead fractures, ensuring continued device function and patient recovery.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- The HeartMate II is a left ventricular assist device (LVAD) used for advanced heart failure.
- Percutaneous lead integrity is vital for continuous LVAD function.
Observation:
- Four patients experienced HeartMate II LVAD pump failure due to percutaneous lead wire fraying and fracture.
- Damage was linked to patient-induced lead twisting or kinking after 6-18 months of LVAD support.
Findings:
- Audible and visual alarms preceded pump failure, allowing for timely intervention.
- Prompt pump exchange resulted in uneventful recovery for all four patients.
- Patients resumed successful LVAD support post-exchange, with some followed for over 600 days.
Implications:
- Highlights the critical need for comprehensive patient education on managing LVAD drivelines to prevent mechanical complications.
- Emphasizes the importance of recognizing alarm signals for early detection of lead damage.
- Suggests potential for design improvements or patient management strategies to mitigate driveline issues.
Abstract:
In four of our patients implanted with the HeartMate II left ventricular assist device (LVAD), fraying and fracture of the percutaneous lead's internal wires led to pump failure. The patients included two adolescent males (age, 15 and 17 years), one adult male (age, 78 years), and one adult female (age, 49 years). The damage was attributed to patient-related twisting or kinking of the lead. The patients had been supported by the LVAD for 6-18 months before the lead was damaged. In each case, audible and visual alarms were activated, and the pump temporarily continued to function well. The patients were rushed to the hospital, and the pumps were exchanged. All four patients recovered uneventfully and were discharged from the hospital 10-14 days later. They continued to do well on LVAD support for up to 639 days after the initial implant procedure. These events show the importance of educating LVAD patients to avoid excessive twisting or kinking of the device's driveline.
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