First Series of Left Ventricular Assist Device Upgrades to HeartMate 3

Background: LVAD exchanges become progressively a standard surgical procedure. The exchange procedure is an opportunity to upgrade patients to a new generation pump which offers e.g., advanced reduction of adverse events or longer battery hours.

Methods: We performed an analysis of six consecutive patients who underwent LVAD upgrade to HeartMate 3 either from a HeartWare of HeartMate II device. Operations were performed minimally invasively through a lateral thoracotomy. Follow up time was six months after LVAD upgrade.

Results: We present four HM II and two HVAD patients, who underwent LVAD upgrade to HM 3. Average age was 57.5 years. At the time of LVAD exchange, all patients were classified as INTERMACS level 3. In five cases LVAD infection led to LVAD exchange (83%, ⅚). The remaining patient underwent LVAD exchange due to pump thrombosis (16%, ⅙). The six month survival after LVAD exchange was 100% (6/6). None of the patients was postoperatively supported by ECMO. No patient experienced postoperative relevant bleeding. One patient suffered a minor cerebral bleeding (16.6%, ⅙). In the six month follow-up examination one patient showed a single syncope and several low flow alarms (⅙). The remaining five patients showed no adverse events or technical malfunctions of the VAD (⅚).

Conclusion: Upgrades from HMII as well from HVAD to HM3 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 upgrade patients to a superior generation of assist device.