In selected patients with left ventricular assist device–associated infection or malfunction, pump exchange may become necessary after conservative treatment options fail and heart transplantation is not readily available. We examined the survival and complication rate in patients (⩾19 years of age) who underwent HeartMate II to HeartMate II exchange at our institution from 1 January 2010 to 28 February 2018. Clinical outcomes were analyzed and compared for patients who underwent exchange for pump thrombosis (14 patients), breach of driveline integrity (5 patients), and device-associated infection (2 patients). There were no differences in 30-day mortality (p = 0.58), need for temporary renal replacement therapy (p = 0.58), right ventricular mechanical support (p = 0.11), and postoperative stroke (p = 0.80) among groups. Survival at 1 year was 90% ± 7% for the whole cohort and 85% ± 10% for those who underwent exchange for pump thrombosis. In patients exchanged for device thrombosis, freedom from re-thrombosis and survival free from pump re-thrombosis at 1 year were 49% ± 16% and 42% ± 15%, respectively. No association of demographic and clinical variables with the risk of recurrent pump thrombosis after the first exchange was identified. Survival after left ventricular assist device exchange compares well with published results after primary left ventricular assist device implantation. However, recurrence of thrombosis was common among patients who required a left ventricular assist device exchange due to pump thrombosis. In this sub-group, consideration should be given to alternative strategies to improve the outcomes.
MoazamiNMilanoCAJohnR, et al. Pump replacement for left ventricular assist device failure can be done safely and is associated with low mortality. Ann Thorac Surg2013; 95(2): 500–505.
2.
ShaikhAFJosephSMLimaB, et al. HeartMate II left ventricular assist device pump exchange: a single-institution experience. Thorac Cardiovasc Surg2017; 65(5): 410–414.
3.
KormosRLCowgerJPaganiFD, et al. The Society of Thoracic Surgeons INTERMACS database annual report: evolving indications, outcomes, and scientific partnerships. Ann Thorac Surg2019; 107(2): 341–353.
4.
TsubotaHRibeiroRVPBilliaF, et al. Left ventricular assist device exchange: the Toronto General Hospital experience. Can J Surg2017; 60(4): 253–259.
5.
KirklinJKNaftelDCKormosRL, et al. Interagency registry for mechanically assisted circulatory support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device. J Heart Lung Transplant2014; 33(1): 12–22.
6.
LevinAPUrielNTakayamaH, et al. Device exchange in HeartMate II recipients: long-term outcomes and risk of thrombosis recurrence. ASAIO J2015; 61(2): 144–149.
7.
HankeJSDoganGWertL, et al. Left ventricular assist device exchange for the treatment of HeartMate II pump thrombosis. J Thorac Dis2018; 10(Suppl. 15): S1728–S1736.
8.
GoldsteinDJMeynsBXieR, et al. Third annual report from the ISHLT mechanically assisted circulatory support registry: a comparison of centrifugal and axial continuous-flow left ventricular assist devices. J Heart Lung Transplant2019; 38(4): 352–363.
9.
LucJGYTchantchaleishviliVPhanK, et al. Medical therapy as compared to surgical device exchange for left ventricular assist device thrombosis: a systematic review and meta-analysis. ASAIO J2019; 65(4): 307–317.
10.
HeumanDMMihasAAHabibA, et al. MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl2007; 13(1): 30–37.
11.
HoranTGaynesRMartoneW, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Contr1992; 20(5): 271–274.
12.
SoleimaniBStephensonERPriceLC, et al. Clinical experience with sternotomy versus subcostal approach for exchange of HeartMate II left ventricular assist device. Ann Thorac Surg2015; 100(5): 1577–1580.
13.
AnandJSinghSKHernandezR, et al. Continuous-flow ventricular assist device exchange is safe and effective in prolonging support time in patients with end-stage heart failure. J Thorac Cardiovasc Surg149(1): 267–275, 278.e1.
14.
OtaTYerebakanHAkashiH, et al. Continuous-flow left ventricular assist device exchange: clinical outcomes. J Heart Lung Transplant2014; 33(1): 65–70.
15.
TchantchaleishviliVLucJGYHaswellJ, et al. Subxiphoid exchange of HeartMate II left ventricular assist device. ASAIO J2017; 63(4): 414–418.
16.
BauerTMChoiJHLucJGY, et al. Device exchange versus nonexchange modalities in left ventricular assist device-specific infections: a systematic review and meta-analysis. Artif Organs2019; 43(5): 448–457.
17.
NassifMELaRueSJRaymerDS, et al. Relationship between anticoagulation intensity and thrombotic or bleeding outcomes among outpatients with continuous-flow left ventricular assist devices. Circ Heart Fail2016; 9(5): e002680.
18.
MartinezBKYikBTranR, et al. Meta-analysis of time in therapeutic range in continuous-flow left ventricular assist device patients receiving warfarin. Artif Organs2018; 42(7): 700–704.
19.
BishopMAStreiffMBEnsorCR, et al. Pharmacist-managed international normalized ratio patient self-testing is associated with increased time in therapeutic range in patients with left ventricular assist devices at an academic medical center. ASAIO J2014; 60(2): 193–198.
20.
KirklinJKNaftelDCPaganiFD, et al. Pump thrombosis in the Thoratec HeartMate II device: an update analysis of the INTERMACS Registry. J Heart Lung Transplant2015; 34(12): 1515–1526.
21.
AlvarezPCordero-ReyesAMUribeC, et al. Acquired and hereditary hypercoagulable states in patients with continuous flow left ventricular assist devices: prevalence and thrombotic complications. J Card Fail2016; 22(7): 501–511.
22.
KosterAHueblerSPotapovE, et al. Impact of heparin-induced thrombocytopenia on outcome in patients with ventricular assist device support: single-institution experience in 358 consecutive patients. Ann Thorac Surg2007; 83(1): 72–76.
23.
WadiaYThiagarajanPDelgadoR, et al. Antiphospholipid syndrome with anti-prothrombin autoantibodies in a patient with an axial-flow left ventricular assist device. J Heart Lung Transplant2005; 24(8): 1133–1136.
24.
FeldmanDPamboukianSVTeutebergJJ, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant2013; 32(2): 157–187.
25.
ChivukulaVKBeckmanJAPriscoAR, et al. Left ventricular assist device inflow cannula angle and thrombosis risk. Circ Heart Fail2018; 11(4): e004325.
26.
PriscoARAlisedaABeckmanJA, et al. Impact of LVAD implantation site on ventricular blood stagnation. ASAIO J2017; 63(4): 392–400.
27.
ChiuW-CAlemuYMcLartyAJ, et al. Ventricular assist device implantation configurations impact overall mechanical circulatory support system thrombogenic potential. ASAIO J2017; 63(3): 285–292.
28.
GalloMTrivediJRSobieskiMA, et al. Surgical technique for ventricular device exchange: from HeartMate II to HVAD. ASAIO J2017; 63(3): 364–366.
29.
SchmittoJDPyaYZimpferD, et al. Long-term evaluation of a fully magnetically levitated circulatory support device for advanced heart failure—two-year results from the HeartMate 3 CE Mark Study. Eur J Heart Fail2019; 21(1): 90–97.
30.
UrielNColomboPCClevelandJC, et al. Hemocompatibility-related outcomes in the MOMENTUM 3 trial at 6 months: a randomized controlled study of a fully magnetically levitated pump in advanced heart failure. Circulation2017; 135(21): 2003–2012.
31.
MehraMRGoldsteinDJUrielN, et al. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med2018; 378(15): 1386–1395.
32.
HudzikBKaczmarskiJPacholewiczJ, et al. Von Willebrand factor in patients on mechanical circulatory support—a double-edged sword between bleeding and thrombosis. Kardiochir Torakochirurgia Pol2015; 12(3): 233–237.
33.
KoeneRJWinSNaksukN, et al. HAS-BLED and CHA(2)DS(2)-VASc scores as predictors of bleeding and thrombotic risk after continuous-flow ventricular assist device implantation. J Card Fail2014; 20(11): 800–807.
