Successful Pregnancy with HeartMate 3 (Abbott) Left Ventricular Assist Device

Abstract

<h3>Introduction</h3> Left ventricular assist devices (LVADs) are an evolving therapy for patients with end-stage heart failure (HF). Due to high maternal and fetal risk from hemodynamic variation and need for anticoagulation, LVADs are a relative contraindication to pregnancy. Successful pregnancies have been observed with axial-flow LVADs as well as the continuous-flow HeartWareTM (Medtronic) LVAD, but the safety of the continuous-flow HeartMate 3TM (HM3) LVAD (Abbott) with pregnancy is unknown. Herein we present a case of a successful delivery in a patient with a HM3 LVAD. <h3>Case Report</h3> A 39-year-old female with peripartum cardiomyopathy underwent HM3 implantation as destination therapy due to severely elevated panel-reactive antibodies. She followed routinely with HF clinic. Two years after implantation, she presented to HF clinic at 15 weeks gestation despite oral birth control. She received counseling on the risk of pregnancy but opted against termination. Spironolactone was discontinued; all other medications (carvedilol, torsemide) were continued. She was anticoagulated with enoxaparin until imaging confirmed that she was no longer in the first trimester and then subsequently resumed warfarin. She underwent transthoracic echocardiogram-guided speed optimization at 20 weeks after her clinical exam demonstrated volume overload. LVAD speed was increased from 5500 to 5700 revolutions per minute. Serial obstetric sonography demonstrated normal fetal anatomy. Fetal echocardiogram and genetic screening were unremarkable. Maternal fetal medicine, anesthesia, and HF cardiology agreed on scheduled cesarean section with bilateral salpingectomy at 34 weeks gestation. At 33 weeks gestation, she switched back to enoxaparin from warfarin with her last dose timed for 24 hours prior to delivery. The patient underwent successful cesarean section with neuraxial anesthesia. During delivery, she was supported with low-dose phenylephrine with return-to-flows in the 80s. A healthy boy was delivered. <h3>Summary</h3> This case supports the notion that HM3 LVADs may provide adequate hemodynamic support during pregnancy and delivery. As previously shown, successful care of patients with LVADs during pregnancy requires a multidisciplinary approach to optimize the health and safety of mother and baby.