Novel Plug Device for HeartMate 3 Explantation: First Multicenter Experience

Area of Science:

• Cardiovascular Surgery
• Mechanical Circulatory Support
• Heart Failure Management

Background:

• Explantation of left ventricular assist devices (LVADs) after myocardial recovery is uncommon but increasingly relevant due to the growing LVAD population.
• Novel strategies are needed for LVAD explantation, particularly for devices like the HeartMate3.

Purpose of the Study:

• To evaluate the safety and efficacy of a custom-made apical ring plug for HeartMate3 LVAD explantation.
• To assess perioperative outcomes, including intensive care unit discharge status, complications, and transfusion requirements.

Main Methods:

• Retrospective review of seven patients undergoing HeartMate3 explantation using a custom-made apical ring plug across four medical centers.
• Procedures were performed via conventional sternotomy or left lateral thoracotomy, with or without cardiopulmonary bypass.
• Outcomes included intensive care unit discharge, perioperative complications (bleeding, embolic, infectious), and transfusion needs.

Main Results:

• The custom-made apical ring plug was implanted without technical difficulties in all seven patients.
• No re-operations for bleeding, hemorrhagic, embolic, or plug-related infections were reported.
• All patients were discharged alive from the intensive care unit, with perioperative transfusions ranging from 0 to 3 units.

Conclusions:

• The novel apical ring plug appears to be a safe and effective device for HeartMate3 LVAD explantation in this initial patient series.
• Further larger studies are warranted to confirm long-term outcomes, as current use remains off-label.