Left Ventricular Assist Device Exchange: Comparing Outcomes of HeartMate2 (HM2), HeartMate3 (HM3) and HeartWare (HVAD) Device Exchanges for Pump Thrombosis
Adaoma V. Ngari, Kunal Kotkar, Marci Damiano, Aki Itoh, Muhammad F. Masood.
Washington University School of Medicine, St. Louis, MO, USA.
Left Ventricular Assist Device (LVAD) exchange is the established treatment for LVAD pump thrombosis; however, INTERMACS data convey complications including re-thrombosis in HM2 to HM2 exchanges. This single center retrospective study compared outcomes of LVAD exchanges for pump thrombosis across three groups: HM2 to HM2, HM2 to HM3 and HVAD to HVAD. Secondly, outcomes of single and multiple HM2 exchanges for reasons including pump thrombosis, pump pocket infection and device malfunction were compared.
Clinical registries INTERMACS and Society of Thoracic Surgeons (STS) were queried to determine patient cohorts. Analysis using Chi-Squared, Kaplan- Meier, Independent T-test and One-Way ANOVA were used. Significance was set at p < 0.05.
83 exchange procedures for pump thrombosis were performed on 68 patients between 1/1/2005 and 12/31/2018 (12 patients received two or more exchanges). 66 (78%) exchanges were HM2 to HM2, 6 (7%) were HM2 to HM3 and 11 (13%) were HVAD to HVAD. Additionally, 65 (83%) patients underwent a single HM2 exchange and 13 (17%) underwent multiple HM2 exchanges. No significant differences in mortality, re-thrombosis, need for subsequent LVAD exchange or adverse events including stroke, infection, bleeding complications or dialysis requirements were found. Kaplan-Meier analysis revealed no significant differences between single and multiple HM 2 exchange groups.
Although data puts forward better outcomes when exchanged to a HM3 or HVAD, statistically significant conclusions are limited by small sample sizes. Conducting a longer study across multiple institutions with a larger pool of participants would likely yield significant and clinically relevant conclusions.
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