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The Journal of Cardiovascular Surgery 2021 May 31

DOI: 10.23736/S0021-9509.21.11756-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Three year follow-up after less-invasive Left Ventricular Assist Device exchange to HeartMate 3

Jasmin S. HANKE, Silvia MARIANI, Ali S. MERZAH, Karl BOUNADER, Tong LI, Axel HAVERICH, Jan D. SCHMITTO, Günes DOGAN

Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany


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BACKGROUND: Device exchange to a newer generation left ventricular assist device (LVAD) offers the opportunity to benefit from improved adverse events profiles. We present the three year results of a patient cohort undergoing VAD upgrades to a new generation device focusing on outcomes and adverse events.
METHODS: We present the first series of patients who underwent LVAD upgrade to HeartMate 3. All operations were performed less invasively. Follow-up time was three years after LVAD exchange.
RESULTS: Overall four HeartMate II and two HVAD patients underwent LVAD upgrade. In five cases severe infection of the VAD led to device exchange (83%, 5/6). Three year survival after LVAD exchange was 100% (6/6). In the follow-up examinations one patient showed a single syncope and several low flow alarms (1/6). The remaining five patients showed no technical malfunctions of the LVAD or hemodynamic adverse events (5/6). Four out of five patients whose devices had to be changed due to an infection suffered a local re-infection (4/5), which, however, did not require any further surgical intervention. Four patients were successfully transplanted and two patients were still on device support at three years after LVAD exchange.
CONCLUSIONS: Three-year outcomes and adverse events after LVAD exchange to HeartMate 3 show excellent results. The superior hemocompatibility in terms of pump thrombosis makes the HM3 a favored choice in case of LVAD exchange due previous pump thrombosis. However, in cases of exchange due to device infection the risk of reinfection remains high.


KEY WORDS: HeartMate 3; HeartMate II; HVAD; LVAD; LVAD exchange; Upgrade; Pump thrombosis; Driveline infection; Device infection; Left Ventricular Assist Device

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