title: HeartMate II Left Ventricular Assist Device Pump Exchange: A Single-Institution Experience.
abstract: BackgroundLeft ventricular assist devices (LVADs) have revolutionized the treatment of patients with end-stage heart failure. These devices are replaced when pump complications arise if heart transplant is not possible. We present our experience with HeartMate II (HMII (Thoratec, Plesanton, California, United States)) LVAD pump exchange.Materials and MethodsWe retrospectively reviewed all cases that required pump exchange due to LVAD complication from November 2011 until June 2016 at a single high-volume institution. The indications, demographics, and outcome were extracted and analyzed.ResultsOf 250 total patients with implanted HMII LVADs, 16 (6%) required pump exchange during the study period. The initial indications for LVAD placement in these patients were bridge to transplantation (n= 6 [37.5%]) or destination therapy (n= 10 [62.5%]). Fifteen patients (93.8%) required pump exchange due to pump thrombosis and 1 (6.2%) due to refractory driveline infection. Nine patients (56.2%) underwent repeat median sternotomy while a left subcostal approach was used in the remaining seven patients. Fifteen patients (93.7%) survived until hospital discharge. During the follow-up period (median, 155 days), 11 patients remained alive and 4 of these underwent successful cardiac transplantation.ConclusionHMII LVAD pump exchange can be safely performed for driveline infection or pump thrombosis when heart transplantation is not an option.
authors.affiliation: College of Medicine, Texas A&M University Health Science Center, Dallas, Texas, United States.
authors.forename: Asad F
authors.initials: AF
authors.lastname: Shaikh
authors.affiliation: Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, United States.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Joseph
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Lima
authors.affiliation: Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, United States.
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Hall
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, United States.
authors.forename: Rajasekhar
authors.initials: R
authors.lastname: Malyala
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, United States.
authors.forename: Aldo E
authors.initials: AE
authors.lastname: Rafael
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, United States.
authors.forename: Gonzalo V
authors.initials: GV
authors.lastname: Gonzalez-Stawinski
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, United States.
authors.forename: Themistokles
authors.initials: T
authors.lastname: Chamogeorgakis
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D013781:Texas; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left