First series of left ventricular assist device exchanges to HeartMate 3.
OBJECTIVE
Left ventricular assist device (LVAD) exchange is becoming a standard surgical procedure. The exchange procedure is an opportunity to upgrade patients to a new generation pump that offers advanced reduction of adverse events or longer battery hours.


METHODS
We performed an analysis of 6 consecutive patients who underwent LVAD exchange to HeartMate 3 either from a HeartWare or HeartMate (HM) II device. Minimally invasive operations were performed through a lateral thoracotomy. Follow-up time was 6 months after LVAD exchange.


RESULTS
We present 4 patients with the HM II and 2 patients with the HeartWare ventricular assist device (HVAD) who underwent LVAD exchange to HM III. The average age was 57.5 years. At the time of the LVAD exchange, all patients were classified as Interagency Registry for Mechanically Assisted Circulatory Support level 3. In 5 cases, LVAD infection led to LVAD exchange (83%, 5/6). The remaining patient underwent LVAD exchange due to pump thrombosis (16%, 1/6). The 6-month survival rate after LVAD exchange was 100% (6/6). None of the patients was postoperatively supported by extracorporeal membrane oxygenation. No patient experienced postoperative relevant bleeding. One patient suffered minor cerebral bleeding (16.6%, 1/6). At the 6-month follow-up examination, 1 patient reported a single syncope and several low-flow alarms (1/6). The remaining 5 patients showed no adverse events or technical malfunctions of the VAD (5/6).


CONCLUSIONS
LVAD exchanges from HM II as well from HVAD to HM 3 are proven to be technically feasible. Due to the advantages and technical improvements of the new-generation pumps, this procedure is an excellent opportunity to give patients access to a superior generation of assist device.
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Jasmin S
JS
Hanke
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Sebastian V
SV
Rojas
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Günes
G
Dogan
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Christina
C
Feldmann
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Erik
E
Beckmann
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Ezin
E
Deniz
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Bettina
B
Wiegmann
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Jana-Elena
JE
Michaelis
Department of Cardiology, Hannover Medical School, Hannover, Germany.
L Christian
LC
Napp
Department of Cardiology, Hannover Medical School, Hannover, Germany.
Dominik
D
Berliner
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Malakh
M
Shrestha
Department of Cardiology, Hannover Medical School, Hannover, Germany.
Johann
J
Bauersachs
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Axel
A
Haverich
Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Jan D
JD
Schmitto
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D006333:Heart Failure / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012086:Reoperation / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D013927:Thrombosis
Driveline infection; HeartMate 3; HeartMate II; HeartMate III; LVAD; LVAD exchange; Left ventricular assist device; Pump thrombosis; Upgrade 