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HVAD to Heartmate 3 Device Exchange: A Society of Thoracic Surgeons Intermacs Analysis

Rebecca Cogswell1, Ryan S Cantor2, Esther Vorovich3

  • 1Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.

The Annals of Thoracic Surgery
|October 22, 2021
PubMed

Insights

Exchanging the HeartWare Ventricular Assist Device (HVAD) to the HeartMate 3 shows increased mortality compared to continued HVAD support. However, for patients needing pump exchange, HeartMate 3 offers superior survival.

Area of Science:

  • Cardiovascular Surgery
  • Medical Device Technology
  • Clinical Outcomes Research

Background:

  • Medtronic announced the discontinuation of the HVAD left ventricular assist device in June 2021.
  • This analysis focuses on surgical risks and survival outcomes related to HVAD device exchanges.

Purpose of the Study:

  • To summarize surgical risks associated with exchanging the HVAD to a HeartMate 3 device.
  • To compare survival rates after HVAD to HeartMate 3 exchange versus primary HVAD implantation.
  • To compare survival outcomes between HVAD to HeartMate 3 and HVAD to HVAD exchange procedures.

Main Methods:

  • Utilized The Society of Thoracic Surgeons Intermacs database to identify three patient cohorts.
  • Cohorts included primary HVAD implant, HVAD to HeartMate 3 exchange, and HVAD to HVAD exchange.
  • Modeled mortality after HVAD to HeartMate 3 exchange and compared it to continued HVAD support.

Main Results:

  • HVAD to HeartMate 3 exchange was linked to significantly reduced survival compared to continued HVAD support (73.8% vs 79.0% at 6 months).
  • Survival was higher after HVAD to HeartMate 3 exchange compared to HVAD to HVAD exchange at 1 year (85.9% vs 66.6%, P = .009).

Conclusions:

  • Exchanging to HeartMate 3 from HVAD significantly increases mortality compared to continued HVAD support.
  • For patients requiring pump exchange while on HVAD support, switching to HeartMate 3 demonstrated superior survival.
  • Currently, there is insufficient evidence to recommend elective exchange from HVAD to HeartMate 3.
Abstract

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