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Device exchange from HeartMate II to HeartMate 3 left ventricular assist device

Koji Takeda1, Hiroo Takayama1, Joseph Sanchez1

  • 1Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY, USA.

Interactive Cardiovascular and Thoracic Surgery
|May 31, 2019
PubMed

Insights

Exchanging the HeartMate II (HMII) left ventricular assist device to the HeartMate 3 (HM3) is feasible. However, risks include pump pocket infection and inflow malposition, necessitating careful patient selection and monitoring.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Device Technology

Background:

  • The HeartMate II (HMII) left ventricular assist device (LVAD) is often exchanged for the HeartMate 3 (HM3) to mitigate risks like device thrombosis and stroke.
  • Data on the outcomes of HMII to HM3 exchange procedures are limited, highlighting the need for further clinical investigation.

Observation:

  • This study reviewed early and mid-term outcomes of 9 patients undergoing HMII to HM3 exchange.
  • Indications for exchange included device thrombosis (8.89%) and driveline injury (1.11%).
  • Procedures were performed via lateral thoracotomy, with a median cardiopulmonary bypass time of 117 minutes.

Findings:

  • In-hospital mortality was 0%. One patient required pump repositioning due to inflow malposition.
  • During a median follow-up of 486 days, 33% of patients developed late HMII pump pocket infection.
  • Five patients successfully received a heart transplant; one patient died from an unknown cause.

Implications:

  • HMII to HM3 exchange is achievable through lateral thoracotomy, offering a potential surgical approach.
  • Potential complications such as inflow malposition and infection of the previous pump pocket require careful consideration and management strategies.
  • Further research is warranted to optimize surgical techniques and patient management for LVAD exchange procedures.

Keywords:
Device thrombosisExchangeVentricular assist device

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