547 An Aggressive Policy of Pump Exchange Can Salvage Most Patients with Pump Malfunction

Abstract

Purpose: Advances have been made in the biocompatibility and durability of ventricular assist devices. Be it rare, device failure is a significant source of morbidity and can be a fatal event if not promptly managed. We sought to describe the management of device malfunction in our institution. Methods and Materials: A single center retrospective study of 165 mechanical assist devices, placed from 7/05-11/11 in 138 patients, (77 Heartmate II; 36 Heartware; 17 Heartmate XVE, 6 Novocor; 19 Thoratec PVAD; 6 Ventracor Ventrassist; 4 Thoratec IVAD) was conducted. Cases of device malfunction were examined. Results: 14 pump malfunctions occurred in 13 patients. 12 patients underwent 13 successfull device exchanges. (3/3) HeartMate XVE to Heartmate II; (1/1)Thoratec PVAD to a second PVAD; (4/5) HeartMate II with thrombus, (3/3) with electrical failure, and (1/1) with bend relief obstruction, to a second HeartMate II. In 1 patient with a thrombosed HeartMate II, care was withdrawn. 3 HeartWare HVADs developed thrombus in 2 patients, and were exchanged to a second and and a subsequent second and third HVAD. 6 patients underwent heart transplantation (3 HeartMate II, 2 HVAD, 1 PVAD). 1 patient was explanted for recovery (HeartMate II). 2 patients expired (Heartmate II), and 3 patients are ongoing (Heartmate II). Conclusions: Device malfunction occurred in 8.5% (14/165) of all pumps placed and in 8.5% (10/118) of continuous flow pumps. For continous flow pumps, pump thrombus 60% (6/10) and electrical failure 30% (3/10) were the most common causes for pump malfunction. An aggressive policy of pump exchange results in successful outcomes in the majority of patients. Device manufacturers should be encouraged to enhance the biocompatability and durability of devices.