Left ventricular assist devices exchange: why, when and how to do it—experience from experts

Schmack, Bastian; Sabashnikov, Anton; Weymann, Alexander; Zeriouh, Mohamed; Koch, Achim; Ruhparwar, Arjang; Simon, Andrè; Popov, Aron Frederik

doi:10.21037/jtd.2018.11.122

Cited by 6 publications

(8 citation statements)

References 23 publications

(27 reference statements)

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“…The median time on bypass during surgery for our patient population was 90 [68-110] min. All but one patient required packed red blood cell transfusions during the procedure [median number of RBCs unit transfused 3] and all required ICU stay after the index procedure with a median length of ICU stay of 13 [6][7][8][9][10][11][12][13][14][15][16][17][18][19] days. None of the patients required post-operative support with extracorporeal membrane oxygenation.…”

Section: Resultsmentioning

confidence: 99%

“…2 Among those, device malfunction (including thrombosis, driveline injury, and infection) might be addressed with a device exchange rather than conservative, medical management alone. [3][4][5][6] Longer time on support may result in an increasing number of patients needing repeat device exchanges. Especially in the setting of promising 5-year outcomes from the Momentum 3 trial, the exchange and upgrade strategy appear appealing as it offers the opportunity to upgrade to a safer, more hemocompatible device.…”

Section: Introductionmentioning

confidence: 99%

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Repeat left ventricular‐assisted device exchange and upgrade from second‐ to third‐generation devices in a high‐volume single center

Kassi,

Avenatti,

Hoang

et al. 2024

Artificial Organs

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BackgroundPump exchange is an established strategy to treat LVAD‐related complications such as thrombosis, infection, and driveline failure. Pump upgrades with an exchange to newer generation devices are being performed to the advantage of the patient on long‐term support. The safety and efficacy of a repeat LVAD exchange with a concomitant upgrade to a third‐generation pump have not been reported.MethodsWe performed a retrospective analysis of all consecutive patients who underwent a repeat LVAD device exchange and upgrade to HeartMate III (HMIII) at Houston Methodist Hospital between December 2018 and December 2020.ResultsFive patients underwent exchange and upgrade to HMIII within the specified timeframe. Four patients had already had two prior exchanges (all HMII to HMII), and one patient had one prior exchange (HVAD to HVAD). In all cases, implantation was performed as destination therapy. The surgical exchange was performed via redo median sternotomy on full cardiopulmonary bypass. No unplanned redo surgery of the device component was required. In‐hospital mortality was 20% in this very high‐risk population. At 1‐, 3‐, and 6‐month follow‐up, all discharged patients were on HMIII support, with no major LVAD‐related adverse events reported.ConclusionWe report the feasibility and safety of a repeat pump exchange with an upgrade to HMIII in a high‐volume center. The decision for medical therapy versus surgical exchange has to be tailored to individual cases based on risk factors and clinical stability but in expert hands, even a re‐redo surgical approach grants options for good medium‐term outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Repeat left ventricular‐assisted device exchange and upgrade from second‐ to third‐generation devices in a high‐volume single center

Kassi,

Avenatti,

Hoang

et al. 2024

Artificial Organs

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“…3 However, the surgical outcome is unsatisfactory because of an extremely high infection recurrence rate. 4 Thus, a multidisciplinary approach is needed for LVAD infection management.…”

Section: Case Reportmentioning

confidence: 99%

“…If local infection cannot be controlled, device exchange for radical infection control must be considered 3 . However, the surgical outcome is unsatisfactory because of an extremely high infection recurrence rate 4 . Thus, a multidisciplinary approach is needed for LVAD infection management.…”

Section: Case Reportmentioning

confidence: 99%

Staged left ventricular assist device reimplantation via the left anterior wall approach for a patient with severe pump pocket infection

et al. 2023

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“…While surgical management of driveline exit site infection is relatively straight forward, more complex surgery is usually required for patients who have deeper pump/pocket and/or mediastinal infection, often requiring plastic surgery involvement for skin defect closure, such as using omental flap for closure (15). LVAD exchange is typically reserved for severe cases that are unresponsive to or fail antibiotic therapy (16,17). However, the outcomes of such interventions, namely successful eradication of infection and mortality benefit after LVAD exchange, are not well understood.…”

Section: Surgery For Lvad Infectionsmentioning

confidence: 99%

Continuous-flow left ventricular assist device systems infections: current outcomes and management strategies

Aburjania¹,

Hay²,

Sohail³

2021

Ann Cardiothorac Surg

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Left ventricular assisted devices (LVADs) are increasingly used for management of patients with advanced heart failure. However, infection remains one of the most commonly reported complications. Diagnosis, as well as treatment of LVAD infections is challenging. There are multiple diagnostic modalities that have been used to assist with accurate diagnosis of LVAD infections. Treatment of the infection can be especially challenging in these patients, given the presence of the implantable device that cannot be easily replaced or removed. There are no clinical trials assessing the best approach to diagnosis, treatment or long-term management of LVAD infections. In this article we review the most recent diagnostic modalities and treatment approaches, as well as offer our guidance on diagnosis and treatment of LVAD infections.

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Left ventricular assist devices exchange: why, when and how to do it—experience from experts

Cited by 6 publications

References 23 publications

Repeat left ventricular‐assisted device exchange and upgrade from second‐ to third‐generation devices in a high‐volume single center

Repeat left ventricular‐assisted device exchange and upgrade from second‐ to third‐generation devices in a high‐volume single center

Staged left ventricular assist device reimplantation via the left anterior wall approach for a patient with severe pump pocket infection

Continuous-flow left ventricular assist device systems infections: current outcomes and management strategies

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