The Journal of Thoracic and Cardiovascular Surgery
Adult: Mechanical Circulatory Support: Expert ReviewHVAD to HeartMate 3 left ventricular assist device exchange: Best practices recommendations
Graphical abstract
Pump exchange of a HeartWare HVAD to HeartMate 3 LVAD. Exchange of the HVAD device should be performed only “for cause,” for example, pump malfunction. The assessment of the surgical risks of the procedure should determine surgical approach and technique for the exchange procedure. Removal of all HVAD device components including the sewing ring and outflow graft is the optimal technique when feasible and safe. Alternative approaches are available, including minimally invasive techniques.
Section snippets
Differences in Device Design and Implications for Medical Management
Both pumps are continuous-flow LVADs with centrifugal flow design.15,16 The HVAD uses a hybrid engineering design to levitate the internal impeller with passive magnetic levitation and a hydrodynamic bearing. It incorporates an optional proprietary pump speed management algorithm, termed the “Lavare Cycle,”17 that is designed to reduce pump and ventricular blood stasis and improve washout. The HeartMate 3 is designed with complete magnetic levitation of the internal impeller that permits
Conclusions
This document outlines important differences that exist in both patient management and techniques for surgical exchange of an HVAD-to-HeartMate 3 exchange. Current data support the recommendation that patients supported with a normally functioning HVAD should remain on support and only undergo exchange “for cause” because the risk of death due to device exchange likely exceeds the risk of death remaining on a normally functioning HVAD device. It is likely that future analyses of data from
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This article has been copublished in The Journal of Thoracic and Cardiovascular Surgery, The Annals of Thoracic Surgery, and European Journal of Cardio-Thoracic Surgery.
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Members of the HeartWare HVAD System to HeartMate 3 Left Ventricular Assist System Exchange Advisory Group are listed in the Acknowledgments.