Abstract
Background: With the improvement in postoperative complications and long-term survival post LVAD, continuing to improve clinical outcomes will require efforts to decrease long-term complications. The purpose of this study is to describe the incidence of mechanical pump failure requiring surgery, which we define as pump failure secondary to either outflow graft compression, outflow graft obstruction, or pump thrombosis requiring surgical intervention. Methods: 141 consecutive adult patients who underwent HeartMate3 Implantation using the “cut-then-sew” implantation technique between September 2015 and September 2021 were included in our study. The primary outcome measure was mechanical pump complication (outflow graft obstruction and or pump thrombosis) requiring surgical intervention. Secondary outcome measures included incidence of bleeding, stroke, renal failure, length of stay, and overall survival. Median follow up was 27.3 months. Results: Eleven (7.8%) of patients developed mechanical pump complications. Six patients developed outflow graft obstruction. Five patients developed acute pump thrombosis. Median time to a mechanical complication was 828 days. Of the 11 patients who underwent surgery, 10 patients (90%) survived to discharge. Overall survival at 1, 3, and 5 years was 82.9%, 69.1% and 55.2% respectively for the entire cohort. Conclusion: The mechanical pump complication rate of 7.8% which is quite high may be related to duration of follow up, as the median time to mechanical complication was 828 days. This study highlights an important late complication that occurs post LVAD implantation.
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Abbreviations
- INTERMACS:
-
Interagency Registry for Mechanically Assisted Circulatory Support
- LVAD:
-
Left ventricular assist device
References
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP et al (2019) Heart Disease and Stroke Statistics—2019 update: a Report from the American Heart Association. Circulation 139:e56–528. https://doi.org/10.1161/CIR.0000000000000659
Srivastava PK, DeVore AD, Hellkamp AS, Thomas L, Albert NM, Butler J et al (2021) Heart failure hospitalization and Guideline-Directed prescribing patterns among heart failure with reduced ejection Fraction Patients. JACC: Heart Failure 9:28–38. https://doi.org/10.1016/j.jchf.2020.08.017
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure (2022) : A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America | Circulation n.d. https://www-ahajournals-org.libproxy.lib.unc.edu/doi/10.1161/CIR.0000000000000509
Mehra MR, Naka Y, Uriel N, Goldstein DJ, Cleveland JC, Colombo PC et al (2017) A fully magnetically levitated circulatory pump for Advanced Heart failure. N Engl J Med 376:440–450. https://doi.org/10.1056/NEJMoa1610426
Mehra MR, Cleveland JC, Uriel N, Cowger JA, Hall S, Horstmanshof D et al (2021) Primary results of long-term outcomes in the MOMENTUM 3 pivotal trial and continued access protocol study phase: a study of 2200 HeartMate 3 left ventricular assist device implants. Eur J Heart Fail 23:1392–1400. https://doi.org/10.1002/ejhf.2211
Mehra MR, Goldstein DJ, Cleveland JC, Cowger JA, Hall S, Salerno CT et al (2022) Five-year outcomes in patients with fully magnetically levitated vs Axial-Flow Left Ventricular assist Devices in the MOMENTUM 3 Randomized Trial. JAMA 328:1233–1242. https://doi.org/10.1001/jama.2022.16197
Wilson HK, Haithcock BE, Caranasos TG (2021) Novel modification of HeartMate 3 implantation. Ann Thorac Surg 111:e133–e134. https://doi.org/10.1016/j.athoracsur.2020.06.123
Bansal A, Akhtar F, Desai S, Velasco-Gonzalez C, Bansal A, Teagle A et al (2022) Six-month outcomes in postapproval HeartMate3 patients: a single-center US experience. J Card Surg 37:1907–1914. https://doi.org/10.1111/jocs.16452
Mezzacappa C, Ravindra NG, Caraballo C, Chouairi F, Miller PE, Clarke J-RD et al (2020) Clinical implications of differences between real world and clinical trial usage of left ventricular assist devices for end stage heart failure. PLoS ONE 15:e0242928. https://doi.org/10.1371/journal.pone.0242928
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Merlo, A., Tasoudis, P., de Oliveira, G.C. et al. Mechanical pump complication after HeartMate 3 implantation. J Thromb Thrombolysis 57, 82–88 (2024). https://doi.org/10.1007/s11239-023-02892-w
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DOI: https://doi.org/10.1007/s11239-023-02892-w