Single Center Experience with the Heartmate 3 Continuous-Flow Ventricular Assist Device in Pediatric Patients

Abstract

Purpose The HeartMate 3 ventricular assist device (VAD) is a newer centrifugal continuous-flow VAD used for bridge-to-transplant and destination therapy in adults. However, there is limited experience regarding its use in children and adolescents. Methods We examined the outcomes of pediatric patients undergoing HeartMate 3 implantation at our institution between January 2016 and September 2020. Indications were bridge-to-transplant and bridge-to-recovery. All patients were in INTERMACS 2 profile at the time of surgery. In the early postoperative period bivalirudin was used as a bridge to warfarin therapy in all patients. Results Seven HeartMate 3 were implanted in five patients, with a median age of 14.5 (9.0-16.5) years, median weight of 48 (40.0-75.0) kg, and median body surface area (BSA) of 1.43 (1.36-1.92) m 2. Of the cohort, all patients but one weighed Conclusion Use of the HeartMate 3 in children and adolescents was associated with no mortality. All patients were successfully implanted and supported, some for several months, indicating that this device is appropriate for older children and adolescents. The HeartMate 3 device in a RVAD configuration was able to provide satisfactory hemodynamic support. The anticoagulation protocol with bivalirudin to warfarin transition proved excellent virtually eliminating bleeding and thromboembolic events.