Repeat left ventricular-assisted device exchange and upgrade from second- to third-generation devices in a high-volume single center

Mahwash Kassi, Eleonora Avenatti, Khanh Doan Hoang, Salma Zook, Rayan Yousafzai, Ashrith Guha, Arvind Bhimaraj, Lin Chiang Philip Chou, Erik Eddie Suarez

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Pump exchange is an established strategy to treat LVAD-related complications such as thrombosis, infection, and driveline failure. Pump upgrades with an exchange to newer generation devices are being performed to the advantage of the patient on long-term support. The safety and efficacy of a repeat LVAD exchange with a concomitant upgrade to a third-generation pump have not been reported. Methods: We performed a retrospective analysis of all consecutive patients who underwent a repeat LVAD device exchange and upgrade to HeartMate III (HMIII) at Houston Methodist Hospital between December 2018 and December 2020. Results: Five patients underwent exchange and upgrade to HMIII within the specified timeframe. Four patients had already had two prior exchanges (all HMII to HMII), and one patient had one prior exchange (HVAD to HVAD). In all cases, implantation was performed as destination therapy. The surgical exchange was performed via redo median sternotomy on full cardiopulmonary bypass. No unplanned redo surgery of the device component was required. In-hospital mortality was 20% in this very high-risk population. At 1-, 3-, and 6-month follow-up, all discharged patients were on HMIII support, with no major LVAD-related adverse events reported. Conclusion: We report the feasibility and safety of a repeat pump exchange with an upgrade to HMIII in a high-volume center. The decision for medical therapy versus surgical exchange has to be tailored to individual cases based on risk factors and clinical stability but in expert hands, even a re-redo surgical approach grants options for good medium-term outcomes.

Original languageEnglish (US)
Pages (from-to)536-542
Number of pages7
JournalArtificial Organs
Volume48
Issue number5
DOIs
StatePublished - May 2024

Keywords

  • HMIII
  • LVAD
  • redo exchange
  • surgical exchange
  • surgical upgrade

ASJC Scopus subject areas

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering

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