Early outcomes with durable left ventricular assist device replacement using the HeartMate 3

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Heart Failure Management

Background:

• The HeartMate 3 (HM3) is a centrifugal, magnetically levitated left ventricular assist device (LVAD) for chronic heart failure.
• Previous trials showed HM3 reduced reoperation needs compared to axial flow LVADs.
• Limited data exists on HM3 use for replacing existing durable LVADs due to complications.

Purpose of the Study:

• To evaluate the safety and efficacy of using the HeartMate 3 (HM3) LVAD as a replacement pump.
• To compare outcomes of HM3 replacement versus other LVADs (Heartmate II, HeartWare) in patients needing device revision.

Main Methods:

• A retrospective analysis of 19 patients receiving HM3 replacement (group 1) versus 85 controls receiving other LVADs (group 2).
• Data collected from an institutional LVAD database (January 2010 - August 2018).
• Primary endpoint: freedom from death or need for subsequent replacement surgery.

Main Results:

• No significant differences in heart failure etiology, indication for replacement, or prior pump duration.
• HM3 group had higher BMI, more prior LVAD implants, and more sternotomies.
• No difference in postoperative adverse event rates between groups.
• HM3 group showed significantly greater freedom from death or reoperation (P=0.039).
• Zero thrombosis events reported in the HM3 replacement group during follow-up.

Conclusions:

• Left ventricular assist device (LVAD) replacement with the HeartMate 3 (HM3) is a safe procedure.
• HM3 may be the preferred choice for patients requiring LVAD replacement due to improved long-term outcomes.
• The study supports HM3 as a viable option for complex LVAD revision cases.