Left Ventricular Assist Device Exchange to HeartMate III Using Minimally Invasive Approach

Abstract

<h3>Purpose</h3> Pump thrombosis, infection or device malfunction are major complications of LVAD that may need to be treated with pump exchange. There is limited data on exchanges to HMIII. Our purpose was to review outcomes of patients undergoing any LVAD to HMIII exchange at our center using minimally invasive approach (subcostal and/or left anterolateral thoracotomy). <h3>Methods</h3> We retrospectively reviewed records of patients undergoing any LVAD to HMIII exchange from January 2016 to October 2020. Pre-operative characteristics, indication, hospitalization course and post discharge data was collected. <h3>Results</h3> Ten patients underwent LVAD (7 HMII, 2 HMIII, 1 HeartWare) to HMIII exchange. Baseline characteristics are described in Table 1. Indications for exchange were pump thrombosis (3), infection + thrombosis (2), malposition (1), malposition + thrombosis (1), outflow graft obstruction from external compression (1), outflow graft twisting and thrombosis (1) and drive line injury (1). All patients underwent minimally invasive approach but 5 needed additional sternotomy to clear abscess collection or due to anatomical complexity. Post exchange, 1 patient needed pericardial window, 1 needed short term hemodialysis, 1 had recurrence of GI bleeding, 1 had CVA on POD 1 and 3 patients needed washout and debridement or hematoma evacuation. There was no change in RV function. Mean length of stay was 20.8 ±2 days. There was only 1 re-admission (sternal wound drainage needing debridement) within 30 days of discharge. There were a total of 8 other admissions (2 for MSSA Bacteremia, 1 for HF exacerbation, 1 for GI bleeding, 1 repeat debridement of sternal wound, 1 for renal failure and 2 for unrelated reasons) within 1 year post discharge. There was no recurrence of thrombosis. Mortality was 0% at 30 days and 0% at 1 year for 5/10 patients (others are alive and less than 1 year from exchange). <h3>Conclusion</h3> LVAD to HMIII exchange with a minimally invasive approach has low surgical mortality and acceptable intermediate- term outcomes.