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HeartMate 3 in Pediatric and Complex Populations: Physiologic Rationale, Patient Selection, and Management Strategies

Tanya Perry1, Jon Edelson2,3, Anna Joong4

  • 1From the Division of Critical Care, Department of Pediatrics, Northwell Health, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|August 5, 2026
PubMed

Insights

The HeartMate 3 (left ventricular assist device) is now used in pediatric and complex congenital heart disease patients. Optimized management and data sharing are crucial for successful outcomes in these unique populations.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Biomedical Engineering

Background:

  • The HeartMate 3 (HM3) left ventricular assist device (LVAD), initially for adults, sees growing use in pediatric patients, small adults, and those with congenital heart disease (CHD).
  • This expansion necessitates a deeper understanding of the device's application in these diverse and complex patient groups.
  • Existing knowledge requires adaptation to address unique physiological and management challenges.

Purpose of the Study:

  • To review and highlight key physiologic and management considerations for using the HM3 LVAD in pediatric, small adult, and CHD populations.
  • To emphasize the importance of understanding device dynamics in relation to patient-specific factors.
  • To underscore the need for a multidisciplinary approach and collaborative data sharing.

Main Methods:

  • Literature review focusing on the application of the HM3 LVAD in non-adult and CHD populations.
  • Analysis of device characteristics, including magnetic levitation and artificial pulse, in relation to patient physiology.
  • Examination of preoperative assessment, postoperative management, and long-term support strategies.

Main Results:

  • The HM3's design mitigates thrombotic risk, but careful management of pump power, flow, and pulsatility index is vital, especially in smaller patients.
  • Preoperative assessment must consider patient size, cardiac dimensions, and anatomy.
  • Postoperative care requires individualized anticoagulation, driveline management, pain control, and specific adaptations for CHD physiologies like Fontan circulation.

Conclusions:

  • Successful HM3 implantation in complex populations demands meticulous preoperative evaluation and tailored postoperative management.
  • A multidisciplinary team approach, comprehensive patient/family education, and psychosocial support are essential.
  • Continued real-world data sharing is critical for refining best practices and optimizing long-term outcomes for these patients.

Keywords:
congenital heart diseaseheart failurepediatricventricular assist device

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